Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 08000466A | IN |
NPI | 1013042308 |
---|---|
Provider Name | Dr. Roger A Ewing |
First Address | Shelbyville, IN 46176-1207 |
Second Address | Shelbyville, IN 46176-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 03/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000209565 | ANTHEM BCBS (01) | IN |
100224280A | (05) | IN |
350045466 | MEDICARE RAILROAD (01) | IN |
4523198 | AETNA (01) | IN |
U24186 | (02) | IN |