Provider Demographics
NPI:1407396427
Name:SECORD, EVAN (DC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SECORD
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 1:105 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-6307
Mailing Address - Country:US
Mailing Address - Phone:904-403-8928
Mailing Address - Fax:
Practice Address - Street 1:940A RIDGEVIEW DR
Practice Address - Street 2:#100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5402
Practice Address - Country:US
Practice Address - Phone:972-521-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor