Provider Demographics
NPI:1841459237
Name:EVANS CHIROPRACTIC PA
Entity type:Organization
Organization Name:EVANS CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:959-929-3602
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22321EVOtherBCBS
MN22321EVOtherBCBS