Healthcare Provider Details

I. General information

NPI: 1932762929
Provider Name (Legal Business Name): EVAN R. BUMGARNER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 NORTH AVE STE 1
GRAND JUNCTION CO
81501-7520
US

IV. Provider business mailing address

609 NORTH AVE STE 1
GRAND JUNCTION CO
81501-7520
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-7700
  • Fax: 970-242-7711
Mailing address:
  • Phone: 970-242-7700
  • Fax: 970-242-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6604
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0008562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: