Provider Demographics
NPI:1568034346
Name:LEGERE, EVAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:PATRICK
Last Name:LEGERE
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 1:11007 VIDA CIR UNIT 107
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2288
Mailing Address - Country:US
Mailing Address - Phone:207-608-5852
Mailing Address - Fax:
Practice Address - Street 1:6771 PROFESSIONAL PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8460
Practice Address - Country:US
Practice Address - Phone:207-608-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor