Provider Demographics
NPI:1225394778
Name:EVANS, ERIK R (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:R
Last Name:EVANS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-5084
Mailing Address - Country:US
Mailing Address - Phone:208-678-4100
Mailing Address - Fax:208-678-4101
Practice Address - Street 1:2621 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-5084
Practice Address - Country:US
Practice Address - Phone:208-678-4100
Practice Address - Fax:208-678-4101
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor