Provider Demographics
NPI:1104934363
Name:DRS EVANS PC
Entity type:Organization
Organization Name:DRS EVANS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-298-4299
Mailing Address - Street 1:1 1/2 CROSSWICKS ST
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505
Mailing Address - Country:US
Mailing Address - Phone:609-298-4299
Mailing Address - Fax:609-298-9653
Practice Address - Street 1:1 THIRD ST
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1321
Practice Address - Country:US
Practice Address - Phone:609-298-4299
Practice Address - Fax:609-298-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00445700111N00000X
NJ38MC00453800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6205500Medicaid
NJ052863Medicare ID - Type Unspecified