Healthcare Provider Details

I. General information

NPI: 1194828012
Provider Name (Legal Business Name): KEVAN JAMES EVANS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W 2ND ST
MARYVILLE MO
64468-2229
US

IV. Provider business mailing address

20293 HAWK RD
MARYVILLE MO
64468-8301
US

V. Phone/Fax

Practice location:
  • Phone: 660-582-8099
  • Fax:
Mailing address:
  • Phone: 660-582-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006606
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006606
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: