Provider Demographics
NPI:1083653133
Name:EVANS, MICHELLE K (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:K
Last Name:EVANS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3958
Mailing Address - Country:US
Mailing Address - Phone:715-848-2526
Mailing Address - Fax:715-848-2225
Practice Address - Street 1:805 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1307
Practice Address - Country:US
Practice Address - Phone:715-748-2334
Practice Address - Fax:715-748-1124
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38945000Medicaid
WI000335789OtherBCBS SMART VALUE
WI610537900OtherUS DEPARTMENT OF LABOR
WI000335789OtherUNICARE
WI99315OtherSECURITY HEALTH PLAN
WI000335789OtherADVOCARE BY SHP
WI000335789OtherHUMANA GOLD CHOICE
WI000335789OtherUNICARE
WI38945000Medicaid