Provider Demographics
NPI:1447280623
Name:EVANS CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:EVANS CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-465-3444
Mailing Address - Street 1:182 MAIN ST
Mailing Address - Street 2:PO BOX 484
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-2114
Mailing Address - Country:US
Mailing Address - Phone:570-465-3444
Mailing Address - Fax:570-465-5400
Practice Address - Street 1:182 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-2114
Practice Address - Country:US
Practice Address - Phone:570-465-3444
Practice Address - Fax:570-465-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC04995L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012964820002Medicaid
PA511796OtherBLUE SHIELD
PA836180OtherAETNA
U33004Medicare UPIN
PA0012964820002Medicaid