Provider Demographics
NPI:1659439636
Name:EVANS, JERRY (DC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:EVANS
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 1:190 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4160
Mailing Address - Country:US
Mailing Address - Phone:541-484-2225
Mailing Address - Fax:541-484-7072
Practice Address - Street 1:190 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4160
Practice Address - Country:US
Practice Address - Phone:541-484-2225
Practice Address - Fax:541-484-7072
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2142111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT93640Medicare UPIN
ORR00WCJXVAMedicare ID - Type Unspecified