Provider Demographics
NPI:1689977373
Name:EVANS, DANIEL RAY (LAC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RAY
Last Name:EVANS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LIBERTY ST SE STE 170
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4149
Mailing Address - Country:US
Mailing Address - Phone:503-588-6633
Mailing Address - Fax:503-540-3427
Practice Address - Street 1:960 LIBERTY ST SE STE 170
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4149
Practice Address - Country:US
Practice Address - Phone:503-588-6633
Practice Address - Fax:503-540-3427
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist