Provider Demographics
NPI:1992720643
Name:EWERT, PAUL R (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
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 1:16 N WATER AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659
Mailing Address - Country:US
Mailing Address - Phone:641-394-3039
Mailing Address - Fax:641-394-6221
Practice Address - Street 1:16 N WATER AVENUE
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659
Practice Address - Country:US
Practice Address - Phone:641-394-3039
Practice Address - Fax:641-394-6221
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO 5459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
28616OtherWELLMARK BCBS OF IA
IA286161Medicaid
28616OtherWELLMARK BCBS OF IA
IA286161Medicaid