Provider Demographics
NPI:1659823599
Name:WELFARE, EVAN P (DC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:P
Last Name:WELFARE
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 1:542 GEORGE WATSON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-8562
Mailing Address - Country:US
Mailing Address - Phone:904-532-3781
Mailing Address - Fax:
Practice Address - Street 1:542 GEORGE WATSON ST
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-8562
Practice Address - Country:US
Practice Address - Phone:904-532-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor