Healthcare Provider Details

I. General information

NPI: 1689663676
Provider Name (Legal Business Name): GERALD DAVID EVANS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 MAIN ST
NEW MILFORD PA
18834-7431
US

IV. Provider business mailing address

937 MAIN ST
NEW MILFORD PA
18834-7431
US

V. Phone/Fax

Practice location:
  • Phone: 570-465-3444
  • Fax: 570-465-5400
Mailing address:
  • Phone: 570-465-3444
  • Fax: 570-465-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC04995L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: