MEDICARE: MR. BRIAN HOWARD EWELL D.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	3446021202	UT

General Provider Information

NPI Number	:	1760459135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN HOWARD EWELL D.C.

Provider Business Mailing Address
First Line	:	2964 WEST 4700 SOUTH
Second Line	:	SUITE 102
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84129-3301
Country	:	US
Telephone Number	:	801-966-9100
Fax Number	:	801-966-0094

Provider Business Practice Location Address
First Line	:	2964 WEST 4700 SOUTH
Second Line	:	SUITE 102
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84129-3301
Country	:	US
Telephone Number	:	801-966-9100
Fax Number	:	801-966-0094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	08/16/2011

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