Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301004187 | MI |
N | 111NN1001X | Nutrition | 2301004187 | MI |
NPI | 1083742183 |
---|---|
Provider Name | Dr. Nicholas C Ewing |
First Address | Troy, MI 48098-5220 |
Second Address | Troy, MI 48098-5220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950F35150 | BLUE CROSS BLUE SHIELD (01) | MI |