MEDICARE: DR. JASON THOMAS EVANS D.C., D.I.B.C.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	868	SD
2	111NI0013X	Independent Medical Examiner Chiropractor	SD868	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1619173523	OTHER	SD	GROUP NPI
3	DQ2901	OTHER	SD	GROUP PTAN
4	1982691911	OTHER	SD	INDIVIDUAL NPI
5	350055130	OTHER	SD	GROUP PTAN

General Provider Information

NPI Number	:	1982691911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON THOMAS EVANS D.C., D.I.B.C.N.

Provider Business Mailing Address
First Line	:	PO BOX 365
Second Line	:
City	:	MADISON
State	:	SD
Zip	:	57042-0365
Country	:	US
Telephone Number	:	605-256-0336
Fax Number	:	605-256-0760

Provider Business Practice Location Address
First Line	:	732 S WASHINGTON AVE
Second Line	:
City	:	MADISON
State	:	SD
Zip	:	57042-3519
Country	:	US
Telephone Number	:	605-256-0336
Fax Number	:	605-256-0760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/05/2010

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