Provider Demographics
NPI:1982910881
Name:EWC 2, LLC
Entity Type:Organization
Organization Name:EWC 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-536-8988
Mailing Address - Street 1:141A BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:JEWETT CITY
Mailing Address - State:CT
Mailing Address - Zip Code:06351-1927
Mailing Address - Country:US
Mailing Address - Phone:860-376-4700
Mailing Address - Fax:860-376-4708
Practice Address - Street 1:141A BROWN AVE
Practice Address - Street 2:
Practice Address - City:JEWETT CITY
Practice Address - State:CT
Practice Address - Zip Code:06351-1927
Practice Address - Country:US
Practice Address - Phone:860-376-4700
Practice Address - Fax:860-376-4708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST WEST CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-30
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty