Provider Demographics
NPI:1346352515
Name:EVANS, ANGELA K (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:EVANS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:K
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1205 HIGHWAY 2 STE 101
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2740
Mailing Address - Country:US
Mailing Address - Phone:208-265-0743
Mailing Address - Fax:
Practice Address - Street 1:1205 HIGHWAY 2 STE 101
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2740
Practice Address - Country:US
Practice Address - Phone:208-265-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010144223OtherBLUE SHIELD
ID870395551OtherCHP
IDC3639OtherBLUE CROSS
ID5485361OtherCCN
ID806677900Medicaid
ID806677900Medicaid
IDU96761Medicare UPIN