Provider Demographics
NPI:1871613182
Name:PAUL EVANS CHIROPRACTIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PAUL EVANS CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-627-6884
Mailing Address - Street 1:5480 PHILADELPHIA ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2486
Mailing Address - Country:US
Mailing Address - Phone:909-627-6884
Mailing Address - Fax:909-627-5558
Practice Address - Street 1:5480 PHILADELPHIA ST
Practice Address - Street 2:SUITE H
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2486
Practice Address - Country:US
Practice Address - Phone:909-627-6884
Practice Address - Fax:909-627-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19643Medicare ID - Type Unspecified