Provider Demographics
NPI:1093867392
Name:EVANS, ERIC TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TIMOTHY
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 1:30 S WARREN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08608-2108
Mailing Address - Country:US
Mailing Address - Phone:609-392-5001
Mailing Address - Fax:609-392-5031
Practice Address - Street 1:30 S WARREN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-2108
Practice Address - Country:US
Practice Address - Phone:609-392-5001
Practice Address - Fax:609-392-5031
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00453800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1D6205500Medicaid
NJ1D6205500Medicaid
NJ489863P7AMedicare UPIN