Healthcare Provider Details

I. General information

NPI: 1336234517
Provider Name (Legal Business Name): CORY T EVANS D.C, CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 S TEJON ST STE 501
COLORADO SPRINGS CO
80903-1530
US

IV. Provider business mailing address

306 E 5TH ST
RUSHVILLE IN
46173-1627
US

V. Phone/Fax

Practice location:
  • Phone: 866-226-8576
  • Fax: 866-286-0255
Mailing address:
  • Phone: 765-265-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002019A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5020
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number1687
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: