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General NPI Number Information
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NPI Number | 1912453135
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Entity Type | Organization
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Legal Business Name | DR. MARSHEA EVANS
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 1068 E14TH STREET
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City | SAN LEANDRO
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State | CA
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Zip | 94577
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Country | US
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Telephone | 510-569-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 1068 E 14TH ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-3731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MARSHEA EVANS
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Credential |
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Telephone | 510-569-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | DC31571
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License Number State | CA
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