Provider Demographics
NPI:1558696757
Name:EVENSEN, CHRISTOPHER STANLEY (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STANLEY
Last Name:EVENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2061
Mailing Address - Country:US
Mailing Address - Phone:435-893-0800
Mailing Address - Fax:435-893-0805
Practice Address - Street 1:1000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701
Practice Address - Country:US
Practice Address - Phone:435-893-0800
Practice Address - Fax:435-893-0805
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9312457-1204207X00000X
MI5101018437207X00000X
VA0102203745207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery