Provider Demographics
NPI:1033343678
Name:EVANS, ROBERT CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
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 1:1909 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-5508
Mailing Address - Country:US
Mailing Address - Phone:512-758-1558
Mailing Address - Fax:512-233-5272
Practice Address - Street 1:1909 GARDEN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-5508
Practice Address - Country:US
Practice Address - Phone:512-758-1558
Practice Address - Fax:512-233-5272
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor