Provider Demographics
NPI:1437181278
Name:EVANS, GARY WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WALTER
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 1:930 TRUXTUN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4700
Mailing Address - Country:US
Mailing Address - Phone:661-321-9006
Mailing Address - Fax:661-321-9068
Practice Address - Street 1:930 TRUXTUN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4700
Practice Address - Country:US
Practice Address - Phone:661-321-9006
Practice Address - Fax:661-321-9068
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0183950Medicaid
CADC0183950Medicare UPIN
CADC0183950Medicaid