Provider Demographics
NPI:1194813147
Name:EVANS, DEAN R (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:R
Last Name:EVANS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:EVANS
Other - Middle Name:
Other - Last Name:CHIROPRACTIC P.A.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4010 W 65TH ST
Mailing Address - Street 2:#217
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1721
Mailing Address - Country:US
Mailing Address - Phone:952-929-3602
Mailing Address - Fax:952-929-4269
Practice Address - Street 1:4010 W 65TH ST
Practice Address - Street 2:#217
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1721
Practice Address - Country:US
Practice Address - Phone:952-929-3602
Practice Address - Fax:952-929-4269
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN678225600Medicaid
MNT39513Medicare UPIN