MEDICARE: DR. EVELYN ANTOINETTE DYSARZ 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	08001032	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000259060	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285635318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVELYN ANTOINETTE DYSARZ D.C.

Provider Business Mailing Address
First Line	:	7117 N OLNEY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3530
Country	:	US
Telephone Number	:	317-841-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	7117 N OLNEY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3530
Country	:	US
Telephone Number	:	317-841-8664
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	02/24/2010

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