MEDICARE: DR. EVAN R WILLIAN 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	10224	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	608213	OTHER	TX	BCBS
2	615276	OTHER	TX	ACN
3	4631607	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1568575421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN R WILLIAN D.C.

Provider Business Mailing Address
First Line	:	210 LAFAYETTE ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1630
Country	:	US
Telephone Number	:	903-856-3665
Fax Number	:	903-856-3692

Provider Business Practice Location Address
First Line	:	210 LAFAYETTE ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1630
Country	:	US
Telephone Number	:	903-856-3665
Fax Number	:	903-856-3692

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	01/27/2015

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