Provider Demographics
NPI:1336416957
Name:EAVENSON, ASHLEY LAUREN (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LAUREN
Last Name:EAVENSON
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 1:10 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-5183
Mailing Address - Country:US
Mailing Address - Phone:618-877-7666
Mailing Address - Fax:
Practice Address - Street 1:10 COBBLESTONE CT
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-5183
Practice Address - Country:US
Practice Address - Phone:618-877-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor