Provider Demographics
NPI:1578157533
Name:MAULTSBY, EVAN GRAY (DC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:GRAY
Last Name:MAULTSBY
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 1:5725 OLEANDER DR STE B6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4749
Mailing Address - Country:US
Mailing Address - Phone:910-368-1528
Mailing Address - Fax:
Practice Address - Street 1:5725 OLEANDER DR STE B6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4749
Practice Address - Country:US
Practice Address - Phone:910-368-1528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor