Provider Demographics
NPI:1194828012
Name:EVANS, KEVAN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:JAMES
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 1:20293 HAWK RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-8301
Mailing Address - Country:US
Mailing Address - Phone:660-582-8948
Mailing Address - Fax:
Practice Address - Street 1:206 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2229
Practice Address - Country:US
Practice Address - Phone:660-582-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006606111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1352500OtherCOMMUNITY HEALTH PLAN
MOU69255Medicare UPIN
MO1352500OtherCOMMUNITY HEALTH PLAN