Provider Demographics
NPI:1043423254
Name:EVANS CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:EVANS CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR ,OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-253-0713
Mailing Address - Street 1:403 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5326
Mailing Address - Country:US
Mailing Address - Phone:304-253-0713
Mailing Address - Fax:304-253-0727
Practice Address - Street 1:403 3RD AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5326
Practice Address - Country:US
Practice Address - Phone:304-253-0713
Practice Address - Fax:304-253-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131329000Medicaid
WV0889901Medicare PIN
WVT91531Medicare UPIN