Provider Demographics
NPI:1215124508
Name:EWALD, MICHAEL CARL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CARL
Last Name:EWALD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 E STATE ROUTE 73
Mailing Address - Street 2:UNIT A
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-8711
Mailing Address - Country:US
Mailing Address - Phone:937-545-8603
Mailing Address - Fax:
Practice Address - Street 1:1555 E STATE ROUTE 73
Practice Address - Street 2:UNIT A
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-8711
Practice Address - Country:US
Practice Address - Phone:937-545-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor