Provider Demographics
NPI:1154298644
Name:MOON, EVAN MARK (DC)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MARK
Last Name:MOON
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 1:9418 48TH AVE W APT 6K
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3755
Mailing Address - Country:US
Mailing Address - Phone:605-660-0845
Mailing Address - Fax:
Practice Address - Street 1:9418 48TH AVE W APT 6K
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3755
Practice Address - Country:US
Practice Address - Phone:605-660-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHIR.CH.70048203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor