Provider Demographics
NPI:1346930021
Name:MAKHOUL, EVANA (DC)
Entity Type:Individual
Prefix:
First Name:EVANA
Middle Name:
Last Name:MAKHOUL
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 1:1738 DAYTON BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-2188
Mailing Address - Country:US
Mailing Address - Phone:423-800-0100
Mailing Address - Fax:
Practice Address - Street 1:1738 DAYTON BLVD STE 114
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-2188
Practice Address - Country:US
Practice Address - Phone:423-800-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor