Provider Demographics
NPI:1508147455
Name:EVANS, HEATHER L (DC, LMT, CLT-LANA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:DC, LMT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 N CENTRAL EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1099
Mailing Address - Country:US
Mailing Address - Phone:469-682-6320
Mailing Address - Fax:
Practice Address - Street 1:10830 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1099
Practice Address - Country:US
Practice Address - Phone:469-682-6320
Practice Address - Fax:214-838-6275
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT034032225700000X
TX14080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist