Provider Demographics
NPI:1265975130
Name:EVIN PEARSALL, DC
Entity type:Organization
Organization Name:EVIN PEARSALL, DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVIN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PEARSALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-255-3042
Mailing Address - Street 1:405 E 19TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3650
Mailing Address - Country:US
Mailing Address - Phone:816-255-3042
Mailing Address - Fax:816-222-0886
Practice Address - Street 1:405 E 19TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3650
Practice Address - Country:US
Practice Address - Phone:816-255-3042
Practice Address - Fax:816-222-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty