MEDICARE: DR. ROLAND S EVANS JR. 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	A06040	IA

General Provider Information

NPI Number	:	1235111659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLAND S EVANS JR. D.C.

Provider Business Mailing Address
First Line	:	PO BOX 467
Second Line	:
City	:	STRAWBERRY POINT
State	:	IA
Zip	:	52076-0467
Country	:	US
Telephone Number	:	563-933-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 ELKADER ST
Second Line	:
City	:	STRAWBERRY POINT
State	:	IA
Zip	:	52076-9423
Country	:	US
Telephone Number	:	563-933-2004
Fax Number	:

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

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	07/08/2007

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