Healthcare Provider Details

I. General information

NPI: 1942223649
Provider Name (Legal Business Name): TROY DEVON EVANS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W HWY 32 SUITE D
STOCKTON MO
65785-0384
US

IV. Provider business mailing address

P.O. BOX 384
STOCKTON MO
65785-0384
US

V. Phone/Fax

Practice location:
  • Phone: 417-808-0225
  • Fax: 417-808-0225
Mailing address:
  • Phone: 417-808-0225
  • Fax: 417-808-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007979
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2004017332
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: