Provider Demographics
NPI:1295704575
Name:EVANS, JOHN BRYANT (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRYANT
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 1:658 WACHESAW RD
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5631
Mailing Address - Country:US
Mailing Address - Phone:843-357-9617
Mailing Address - Fax:843-357-9639
Practice Address - Street 1:658 WACHESAW RD
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5631
Practice Address - Country:US
Practice Address - Phone:843-357-9617
Practice Address - Fax:843-357-9639
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH459Medicaid
SCU89478Medicare UPIN
SC7976Medicare PIN