Healthcare Provider Details

I. General information

NPI: 1043756562
Provider Name (Legal Business Name): DOUGLAS RYAN EVENHOUSE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 MERRILLVILLE RD STE 9
CROWN POINT IN
46307-2710
US

IV. Provider business mailing address

1119 MERRILLVILLE RD STE 9
CROWN POINT IN
46307-2710
US

V. Phone/Fax

Practice location:
  • Phone: 800-631-9275
  • Fax: 855-636-2923
Mailing address:
  • Phone: 800-631-9275
  • Fax: 855-636-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003327A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: