MEDICARE: DR. DONALD AMUSSEN EVANS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B354	NV

General Provider Information

NPI Number	:	1205936259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD AMUSSEN EVANS D.C.

Provider Business Mailing Address
First Line	:	4555 E CHARLESTON BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5510
Country	:	US
Telephone Number	:	702-457-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 E CHARLESTON BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5510
Country	:	US
Telephone Number	:	702-457-2225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/09/2007

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