Individual
MR. DEREK ALAN EWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1960 S 11TH ST, NILES, MI 49120-4059
(268) 683-6800
(269) 683-6888
Mailing address
53062 CEDAR LAKE CT, GRANGER, IN 46530-5847
(574) 676-6311
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IN
Other
Enumeration date
08/04/2006
Last updated
07/08/2007
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