Provider Demographics
NPI:1104982289
Name:FIEDLER, EVAN S (DC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:S
Last Name:FIEDLER
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 1:124 S LYNNHAVEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7420
Mailing Address - Country:US
Mailing Address - Phone:757-463-9355
Mailing Address - Fax:
Practice Address - Street 1:124 S LYNNHAVEN RD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7420
Practice Address - Country:US
Practice Address - Phone:757-463-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor