Provider Demographics
NPI:1932762929
Name:BUMGARNER, EVAN R (DC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:R
Last Name:BUMGARNER
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 1:609 NORTH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7520
Mailing Address - Country:US
Mailing Address - Phone:970-242-7700
Mailing Address - Fax:970-242-7711
Practice Address - Street 1:609 NORTH AVE STE 1
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7520
Practice Address - Country:US
Practice Address - Phone:970-242-7700
Practice Address - Fax:970-242-7711
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6604111N00000X
COCHR.0008562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor