Provider Demographics
NPI:1740533645
Name:EWING, TIMOTHY (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:EWING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1207
Mailing Address - Country:US
Mailing Address - Phone:317-389-4404
Mailing Address - Fax:
Practice Address - Street 1:103 S TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1207
Practice Address - Country:US
Practice Address - Phone:317-389-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002089A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11140Medicare PIN