Provider Demographics
NPI:1689663676
Name:EVANS, GERALD DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
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 1:937 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-7431
Mailing Address - Country:US
Mailing Address - Phone:570-465-3444
Mailing Address - Fax:570-465-5400
Practice Address - Street 1:937 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-7431
Practice Address - Country:US
Practice Address - Phone:570-465-3444
Practice Address - Fax:570-465-5400
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC04995L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA836180OtherAETNA
PA0012964820002Medicaid
PA511796OtherBLUE SHIELD
PA511796OtherBLUE SHIELD
U33004Medicare UPIN