Provider Demographics
NPI:1205840394
Name:EVANS, PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
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 1:5480 PHILADELPHIA ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2486
Mailing Address - Country:US
Mailing Address - Phone:909-627-6884
Mailing Address - Fax:909-627-5558
Practice Address - Street 1:5480 PHILADELPHIA ST
Practice Address - Street 2:SUITE H
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2486
Practice Address - Country:US
Practice Address - Phone:909-627-6884
Practice Address - Fax:909-627-5558
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19643Medicare ID - Type Unspecified