Provider Demographics
NPI:1639416423
Name:EWING CHIROPRACTIC LLC
Entity type:Organization
Organization Name:EWING CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PORCIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-661-6129
Mailing Address - Street 1:3809 BROOKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273
Mailing Address - Country:US
Mailing Address - Phone:404-661-6129
Mailing Address - Fax:
Practice Address - Street 1:2417 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032
Practice Address - Country:US
Practice Address - Phone:404-661-6129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO 70081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty