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General NPI Number Information
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NPI Number | 1831215185
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Entity Type | Individual
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Provider Name | FREDERICK WILLIAM EVANS D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3071 BRECKENRIDGE LN
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City | LOUISVILLE
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State | KY
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Zip | 40220-2101
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Country | US
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Telephone | 502-459-4150
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Fax | 502-459-4662
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Provider Business Mailing Address
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Address Line | 8404 SPRUCE HILL RD
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City | PROSPECT
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State | KY
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Zip | 40059-7402
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Country | US
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Telephone | 502-749-8825
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Fax | 502-749-8826
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4122
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License Number State | KY
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