Healthcare Provider Details

I. General information

NPI: 1568575421
Provider Name (Legal Business Name): EVAN R WILLIAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LAFAYETTE ST
PITTSBURG TX
75686-1630
US

IV. Provider business mailing address

210 LAFAYETTE ST
PITTSBURG TX
75686-1630
US

V. Phone/Fax

Practice location:
  • Phone: 903-856-3665
  • Fax: 903-856-3692
Mailing address:
  • Phone: 903-856-3665
  • Fax: 903-856-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: