Provider Demographics
NPI:1386906998
Name:EWERT, ERIC W (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:EWERT
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 1:1506 AINSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4402
Mailing Address - Country:US
Mailing Address - Phone:919-772-4593
Mailing Address - Fax:
Practice Address - Street 1:1506 AINSWORTH ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4402
Practice Address - Country:US
Practice Address - Phone:919-772-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor