MEDICARE: DR. CORY T EVANS D.C, CNIM

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	08002019A	IN
2	111N00000X	Chiropractor	5020	KY
3	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	1687

General Provider Information

NPI Number	:	1336234517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY T EVANS D.C, CNIM

Provider Business Mailing Address
First Line	:	306 E 5TH ST
Second Line	:
City	:	RUSHVILLE
State	:	IN
Zip	:	46173-1627
Country	:	US
Telephone Number	:	765-265-0698
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 S TEJON ST STE 501
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1530
Country	:	US
Telephone Number	:	866-226-8576
Fax Number	:	866-286-0255

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/13/2013

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