Provider Demographics
NPI:1811299316
Name:EWEN, SUSAN EMILY (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:EMILY
Last Name:EWEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2715
Mailing Address - Country:US
Mailing Address - Phone:563-570-0812
Mailing Address - Fax:
Practice Address - Street 1:222 10TH AVE E # 52803
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-3114
Practice Address - Country:US
Practice Address - Phone:309-787-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor