Provider Demographics
NPI:1124049580
Name:EVANSON, DANIEL HOLM (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HOLM
Last Name:EVANSON
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 1:7275 147TH ST W
Mailing Address - Street 2:STE 104
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7809
Mailing Address - Country:US
Mailing Address - Phone:952-431-3133
Mailing Address - Fax:
Practice Address - Street 1:14750 CEDAR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4506
Practice Address - Country:US
Practice Address - Phone:952-431-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNC4302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN349C7HAOtherBLUE CROSS CLINIC ID
MN349C8EVOtherBLUE CROSS IND. ID
MN349C8EVOtherBLUE CROSS IND. ID