Provider Demographics
NPI:1679858922
Name:DURRER, EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:DURRER
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 1:1424 GREENBRIER PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1696
Mailing Address - Country:US
Mailing Address - Phone:434-249-9122
Mailing Address - Fax:
Practice Address - Street 1:1424 GREENBRIER PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1696
Practice Address - Country:US
Practice Address - Phone:434-249-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009809111N00000X
VA0104556959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor