Provider Demographics
NPI:1790082063
Name:PEARSALL, EVIN ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:EVIN
Middle Name:ELLEN
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:64054-1215
Mailing Address - Country:US
Mailing Address - Phone:816-254-4624
Mailing Address - Fax:
Practice Address - Street 1:100 S STERLING AVE
Practice Address - Street 2:
Practice Address - City:SUGAR CREEK
Practice Address - State:MO
Practice Address - Zip Code:64054-1215
Practice Address - Country:US
Practice Address - Phone:816-254-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor