Active NPI
Bruce A Ewoldt
- Chiropractor
- Hull, IA
National Provider Identifier
1831163088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- A5116
- Practice address
- 1134 Main St.
PO Box 808
Hull, IA 51239 - Phone
- (712) 439-2936
- NPI assigned
- Feb 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | A5116 | IA | Primary |
Addresses
Primary practice location
1134 Main St.
PO Box 808
Hull, IA 51239
Mailing address
PO Box 808
Hull, IA 51239-0808
Phone (712) 439-2936
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0231944 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A5116 | IA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558656000000",
"number": "1831163088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 808",
"city": "HULL",
"state": "IA",
"postal_code": "512390808",
"telephone_number": "712-439-2936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1134 MAIN ST.",
"address_2": "PO BOX 808",
"city": "HULL",
"state": "IA",
"postal_code": "51239",
"telephone_number": "712-439-2936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWOLDT",
"first_name": "BRUCE",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-15",
"last_updated": "2019-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IA",
"license": "A5116",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0231944",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hull, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.