Provider Demographics
NPI:1326196775
Name:EVANS, LAUREN ALIDA (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ALIDA
Last Name:EVANS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 VENTURA BLVD. PMB 756
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:323-655-8528
Mailing Address - Fax:323-677-2123
Practice Address - Street 1:508 S. SAN VICENTE BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:323-655-8528
Practice Address - Fax:323-677-2123
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29164111N00000X
CADC29164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor