Provider Demographics
NPI:1154631349
Name:ELIESHA R EVANS DC SC
Entity type:Organization
Organization Name:ELIESHA R EVANS DC SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIESHA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-785-5515
Mailing Address - Street 1:15720W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5119
Mailing Address - Country:US
Mailing Address - Phone:262-785-5515
Mailing Address - Fax:262-785-5525
Practice Address - Street 1:15720W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5119
Practice Address - Country:US
Practice Address - Phone:262-785-5515
Practice Address - Fax:262-785-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty