Provider Demographics
NPI:1043756562
Name:EVENHOUSE, DOUGLAS RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RYAN
Last Name:EVENHOUSE
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 1:1425 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1386
Mailing Address - Country:US
Mailing Address - Phone:219-322-6942
Mailing Address - Fax:
Practice Address - Street 1:566 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3412
Practice Address - Country:US
Practice Address - Phone:219-213-2315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013058111N00000X
IN08003327A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor