Provider Demographics
NPI:1245317528
Name:EVANS, DAVID M (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
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:PO BOX 163118
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-9118
Mailing Address - Country:US
Mailing Address - Phone:916-447-3344
Mailing Address - Fax:
Practice Address - Street 1:1210 G ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-1516
Practice Address - Country:US
Practice Address - Phone:916-447-3344
Practice Address - Fax:916-447-3388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-09-26
Deactivation Date:2007-12-07
Deactivation Code:
Reactivation Date:2012-04-13
Provider Licenses
StateLicense IDTaxonomies
CADC-28369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU9595200Medicare UPIN
CADC0283690Medicare ID - Type Unspecified