Healthcare Provider Details

I. General information

NPI: 1356749030
Provider Name (Legal Business Name): EVANS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N DUPONT HWY
DOVER DE
19901-3961
US

IV. Provider business mailing address

2152 ALLEY CORNER RD
CLAYTON DE
19938-2633
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-0600
  • Fax: 302-677-0605
Mailing address:
  • Phone: 484-678-3880
  • Fax: 302-677-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000640
License Number StateDE

VIII. Authorized Official

Name: DR. KIRK C EVANS
Title or Position: OWNER
Credential: D.C.
Phone: 484-678-3880