Provider Demographics
NPI:1336234517
Name:EVANS, CORY T (DC, CNIM)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:T
Last Name:EVANS
Suffix:
Gender:M
Credentials:DC, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1627
Mailing Address - Country:US
Mailing Address - Phone:765-265-0698
Mailing Address - Fax:
Practice Address - Street 1:13 S TEJON ST STE 501
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1530
Practice Address - Country:US
Practice Address - Phone:866-226-8576
Practice Address - Fax:866-286-0255
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002019A111N00000X
KY5020111N00000X
1687246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor