Provider Demographics
NPI:1578993820
Name:EVANS, JENNIFER MARLENA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARLENA
Last Name:EVANS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 W FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8267
Mailing Address - Country:US
Mailing Address - Phone:843-992-7604
Mailing Address - Fax:
Practice Address - Street 1:1601A W LUCAS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-1225
Practice Address - Country:US
Practice Address - Phone:843-773-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-24
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC .3882 DC111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program