Provider Demographics
NPI:1386725190
Name:LEFEVRE,, EVAN J (DC, PC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:J
Last Name:LEFEVRE,
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 N 400 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7539
Mailing Address - Country:US
Mailing Address - Phone:435-752-4747
Mailing Address - Fax:435-787-9422
Practice Address - Street 1:1415 N 400 E
Practice Address - Street 2:SUITE A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7539
Practice Address - Country:US
Practice Address - Phone:435-752-4747
Practice Address - Fax:435-787-9422
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT97-346266-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU67790Medicare UPIN