MEDICARE: DR. ROY CLARK EVANS 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	CH2803	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2579480	OTHER	WA	AETNA
2	0292244	OTHER	WA	CIGNA
3	EV5391	OTHER	WA	REGENCE

General Provider Information

NPI Number	:	1609911304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY CLARK EVANS D.C.

Provider Business Mailing Address
First Line	:	1709 STATE AVE NE
Second Line	:	SUITE 200
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4556
Country	:	US
Telephone Number	:	360-570-8151
Fax Number	:	360-943-6602

Provider Business Practice Location Address
First Line	:	1217 4TH AVE E
Second Line	:	SUITE 200
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4246
Country	:	US
Telephone Number	:	360-570-8151
Fax Number	:	360-943-6602

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	06/29/2016

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