MEDICARE: DR. EVAN LEVINE 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	X011031	NY

General Provider Information

NPI Number	:	1548345853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN LEVINE D.C.

Provider Business Mailing Address
First Line	:	306 W 80TH ST
Second Line	:	APT 6B
City	:	NEW YORK
State	:	NY
Zip	:	10024-5709
Country	:	US
Telephone Number	:	646-734-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 FRONT ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4605
Country	:	US
Telephone Number	:	914-962-8349
Fax Number	:	914-962-2699

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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