MEDICARE: DR. EVAN ROBERT STRAHL DC

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	CHIR010528	GA

General Provider Information

NPI Number	:	1356922280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN ROBERT STRAHL DC

Provider Business Mailing Address
First Line	:	17867 WATER CHASE TRL
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-8875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4535 WINTERS CHAPEL RD
Second Line	:
City	:	DORAVILLE
State	:	GA
Zip	:	30360-2705
Country	:	US
Telephone Number	:	616-502-8045
Fax Number	:

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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