Provider Demographics
NPI:1205011301
Name:EVANS, CHRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
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 1:1437 W MONTROSE AVE
Mailing Address - Street 2:A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1348
Mailing Address - Country:US
Mailing Address - Phone:773-935-3273
Mailing Address - Fax:773-935-6022
Practice Address - Street 1:1437 W MONTROSE AVE
Practice Address - Street 2:A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1348
Practice Address - Country:US
Practice Address - Phone:773-935-3273
Practice Address - Fax:773-935-6022
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208891Medicare PIN