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General NPI Number Information
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NPI Number | 1861961211
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Entity Type | Organization
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Legal Business Name | EWEN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/15/2018
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 222 10TH AVE E
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City | MILAN
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State | IL
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Zip | 61264-3114
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Country | US
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Telephone | 309-787-9660
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Fax | 309-787-9678
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Provider Business Mailing Address
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Address Line | 222 10TH AVE E
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City | MILAN
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State | IL
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Zip | 61264-3114
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Country | US
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Telephone | 309-787-9660
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Fax | 309-787-9678
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC PHYSICIAN
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Name | DR. SUSAN EMILY EWEN
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Credential | DC
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Telephone | 563-570-0812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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