Provider Demographics
NPI:1396833018
Name:EVANS, KEVIN RONNY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RONNY
Last Name:EVANS
Suffix:
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 1:1910 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:LYND
Mailing Address - State:MN
Mailing Address - Zip Code:56157
Mailing Address - Country:US
Mailing Address - Phone:507-828-2600
Mailing Address - Fax:
Practice Address - Street 1:1910 COUNTY ROAD 20
Practice Address - Street 2:
Practice Address - City:LYND
Practice Address - State:MN
Practice Address - Zip Code:56157
Practice Address - Country:US
Practice Address - Phone:507-828-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21924OtherSIOUX VALLEY HEALTH PLAN
MN803528800Medicaid
MN3D662EVOtherBLUE CROSS BLUE SHIELD