Provider Demographics
NPI:1578194981
Name:EVANS, CHANCE ANDREW
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:ANDREW
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 N UNIVERSITY DR APT 314
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2608
Mailing Address - Country:US
Mailing Address - Phone:713-208-9407
Mailing Address - Fax:
Practice Address - Street 1:4704 N UNIVERSITY DR APT 314
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2608
Practice Address - Country:US
Practice Address - Phone:713-208-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer