Provider Demographics
NPI:1770702474
Name:EWART, GREG ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALLEN
Last Name:EWART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5111 PETER TAYLOR PARK DR
Mailing Address - Street 2:#300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7539
Mailing Address - Country:US
Mailing Address - Phone:615-309-4987
Mailing Address - Fax:615-309-4989
Practice Address - Street 1:5111 PETER TAYLOR PARK DR
Practice Address - Street 2:#300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7539
Practice Address - Country:US
Practice Address - Phone:615-309-4987
Practice Address - Fax:615-309-4989
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC-560111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDC-560OtherSTATE LICENSE NUMBER
TN3674358Medicare ID - Type Unspecified
TN75693Medicare UPIN