Healthcare Provider Details

I. General information

NPI: 1811983208
Provider Name (Legal Business Name): EWING MACROY MILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 HOPWOOD COOLSPRING RD
HOPWOOD PA
15445-2225
US

IV. Provider business mailing address

PO BOX 86 174 HOPWOOD-COOLSPRING ROAD
HOPWOOD PA
15445-0086
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-9849
  • Fax: 724-437-8952
Mailing address:
  • Phone: 724-437-9849
  • Fax: 724-437-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-006922-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: