Provider Demographics
NPI:1083826101
Name:EVANS, BRANDEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:
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 1:140 VANN ST NE
Mailing Address - Street 2:STE400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7297
Mailing Address - Country:US
Mailing Address - Phone:678-852-3728
Mailing Address - Fax:770-629-1330
Practice Address - Street 1:140 VANN ST NE
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7297
Practice Address - Country:US
Practice Address - Phone:678-852-3728
Practice Address - Fax:770-629-1330
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor