Provider Demographics
NPI:1235111659
Name:EVANS, ROLAND S JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:S
Last Name:EVANS
Suffix:JR
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:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52076-0467
Mailing Address - Country:US
Mailing Address - Phone:563-933-2004
Mailing Address - Fax:
Practice Address - Street 1:103 ELKADER ST
Practice Address - Street 2:
Practice Address - City:STRAWBERRY POINT
Practice Address - State:IA
Practice Address - Zip Code:52076-9423
Practice Address - Country:US
Practice Address - Phone:563-933-2004
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15649Medicare ID - Type Unspecified
IA40185Medicare UPIN