MEDICARE: BRIAN H. EWELL, D.C.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	344-6021202	UT

General Provider Information

NPI Number	:	1457760670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN H. EWELL, D.C.,P.C.

Provider Business Mailing Address
First Line	:	2964 W 4700 S
Second Line	:	SUITE 102
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129-2557
Country	:	US
Telephone Number	:	801-966-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2964 W 4700 S
Second Line	:	SUITE 102
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129-2557
Country	:	US
Telephone Number	:	801-966-9100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CHIROPRACTIC PHYSICIAN
Name	:	BRIAN EWELL
Credential	:	D.C.
Telephone Number	:	801-966-9100

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	08/13/2014

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