Healthcare Provider Details

I. General information

NPI: 1790082063
Provider Name (Legal Business Name): EVIN ELLEN PEARSALL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S STERLING AVE
SUGAR CREEK MO
64054-1215
US

IV. Provider business mailing address

100 S STERLING AVE
SUGAR CREEK MO
64054-1215
US

V. Phone/Fax

Practice location:
  • Phone: 816-254-4624
  • Fax:
Mailing address:
  • Phone: 816-254-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2011002319
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: