Provider Demographics
NPI:1447369079
Name:BEANE, EVAN JON (DC)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JON
Last Name:BEANE
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 1:68 N HIGH ST
Mailing Address - Street 2:SUITE E 106
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8915
Mailing Address - Country:US
Mailing Address - Phone:614-855-5454
Mailing Address - Fax:614-283-5400
Practice Address - Street 1:68 N HIGH ST
Practice Address - Street 2:SUITE E 106
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8915
Practice Address - Country:US
Practice Address - Phone:614-855-5454
Practice Address - Fax:614-283-5400
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184312Medicaid
000000119618OtherANTHEM
9291331Medicare ID - Type Unspecified
OH0184312Medicaid