Provider Demographics
NPI:1700836590
Name:EVANS, WILLIAM ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:EVANS
Suffix:JR
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 1:2301 E OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5924
Mailing Address - Country:US
Mailing Address - Phone:918-683-5526
Mailing Address - Fax:918-683-2017
Practice Address - Street 1:2301 E OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5924
Practice Address - Country:US
Practice Address - Phone:918-683-5526
Practice Address - Fax:918-683-2017
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00064232Medicare ID - Type UnspecifiedRAILROAD MEDICARE ID
OK800522328Medicare ID - Type UnspecifiedMEDICARE GROUP #
OKDA5894Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
OK248404401Medicare ID - Type UnspecifiedMEDICARE ID
OK97889Medicare UPIN