Provider Demographics
NPI:1851745301
Name:EVANS, DANIEL BARTLETTE (DC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BARTLETTE
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 1:5646 BRADY DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3009
Mailing Address - Country:US
Mailing Address - Phone:404-630-0504
Mailing Address - Fax:
Practice Address - Street 1:5646 BRADY DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3009
Practice Address - Country:US
Practice Address - Phone:404-630-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor