Provider Demographics
NPI:1770962334
Name:DALTON-EVANS, CHELSEA BLAIR
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:BLAIR
Last Name:DALTON-EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 S KENT DES MOINES RD
Mailing Address - Street 2:APT #224
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4212
Mailing Address - Country:US
Mailing Address - Phone:253-778-5686
Mailing Address - Fax:
Practice Address - Street 1:4821 S KENT DES MOINES RD
Practice Address - Street 2:APT #224
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4212
Practice Address - Country:US
Practice Address - Phone:253-778-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60520659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor