Provider Demographics
NPI:1992704688
Name:EVANS, KEITH ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALAN
Last Name:EVANS
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 1:9898 COLONNADE BLVD
Mailing Address - Street 2:#17202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2247
Mailing Address - Country:US
Mailing Address - Phone:409-781-1668
Mailing Address - Fax:
Practice Address - Street 1:4220 TREADWAY RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7105
Practice Address - Country:US
Practice Address - Phone:409-833-5600
Practice Address - Fax:409-833-2111
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2010-06-16
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TX5213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0631OtherBLUE CROSS BLUE SHIELD
TX8F0631OtherBLUE CROSS BLUE SHIELD
TX8835NOMedicare PIN