Provider Demographics
NPI:1801923461
Name:DELSON, EVALINE ETTA (DC, CCEP)
Entity type:Individual
Prefix:DR
First Name:EVALINE
Middle Name:ETTA
Last Name:DELSON
Suffix:
Gender:F
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5304
Mailing Address - Country:US
Mailing Address - Phone:843-556-0101
Mailing Address - Fax:843-556-8186
Practice Address - Street 1:1322 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5304
Practice Address - Country:US
Practice Address - Phone:843-556-0101
Practice Address - Fax:843-556-8186
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH-2341Medicaid