Provider Demographics
NPI:1942338280
Name:EVANS, JACQUELINE MOORE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MOORE
Last Name:EVANS
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:PO BOX 182542
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76096-2542
Mailing Address - Country:US
Mailing Address - Phone:832-725-7406
Mailing Address - Fax:180-038-1920
Practice Address - Street 1:2408 WHEELER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5250
Practice Address - Country:US
Practice Address - Phone:832-725-7406
Practice Address - Fax:800-381-9202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 4488111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician