Provider Demographics
NPI:1194886655
Name:GEORGE T EVANS DC PC
Entity type:Organization
Organization Name:GEORGE T EVANS DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:970-874-1245
Mailing Address - Street 1:540 MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1834
Mailing Address - Country:US
Mailing Address - Phone:970-874-1245
Mailing Address - Fax:
Practice Address - Street 1:540 MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1834
Practice Address - Country:US
Practice Address - Phone:970-874-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty