Provider Demographics
NPI:1851648604
Name:EIGEN, EVAN (DC)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:EIGEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1362
Mailing Address - Country:US
Mailing Address - Phone:320-774-1013
Mailing Address - Fax:
Practice Address - Street 1:171 7TH AVE S
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1362
Practice Address - Country:US
Practice Address - Phone:320-774-1013
Practice Address - Fax:320-774-1016
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor