Provider Demographics
NPI:1083683882
Name:EVANS, RUSSELL LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:LEWIS
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 1:400 W RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4133
Mailing Address - Country:US
Mailing Address - Phone:501-268-1800
Mailing Address - Fax:501-268-1815
Practice Address - Street 1:400 W RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4133
Practice Address - Country:US
Practice Address - Phone:501-268-1800
Practice Address - Fax:501-268-1815
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U165Medicare ID - Type UnspecifiedMEDICARE