Provider Demographics
NPI:1598989618
Name:EVANS, MICHELLE ATHALIE (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ATHALIE
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 1:2313 LOCKHILL SELMA RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3007
Mailing Address - Country:US
Mailing Address - Phone:210-446-3097
Mailing Address - Fax:
Practice Address - Street 1:7039 SAN PEDRO AVE. SUITE #508
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6216
Practice Address - Country:US
Practice Address - Phone:210-446-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84T540OtherBLUE CROSS BLUE SHIELD #
TX84T540OtherBLUE CROSS BLUE SHIELD