Provider Demographics
NPI:1710173604
Name:EVANGEL, MICHAEL STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEVEN
Last Name:EVANGEL
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 1:343 PARAMUS RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1511
Mailing Address - Country:US
Mailing Address - Phone:201-447-3800
Mailing Address - Fax:201-447-3801
Practice Address - Street 1:343 PARAMUS RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1511
Practice Address - Country:US
Practice Address - Phone:201-447-3800
Practice Address - Fax:201-447-3801
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00300100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ450466Medicare PIN
NJT82434Medicare UPIN