Provider Demographics
NPI:1437544855
Name:EVANS, RAYMOND COREY (DC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:COREY
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 1:8370 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6104
Mailing Address - Country:US
Mailing Address - Phone:716-632-3435
Mailing Address - Fax:716-632-8491
Practice Address - Street 1:8370 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6104
Practice Address - Country:US
Practice Address - Phone:716-632-3435
Practice Address - Fax:716-632-8491
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor