MEDICARE: PAUL EVANS CHIROPRACTIC PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1871613182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL EVANS CHIROPRACTIC PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5480 PHILADELPHIA ST
Second Line	:	SUITE H
City	:	CHINO
State	:	CA
Zip	:	91710-2486
Country	:	US
Telephone Number	:	909-627-6884
Fax Number	:	909-627-5558

Provider Business Practice Location Address
First Line	:	5480 PHILADELPHIA ST
Second Line	:	SUITE H
City	:	CHINO
State	:	CA
Zip	:	91710-2486
Country	:	US
Telephone Number	:	909-627-6884
Fax Number	:	909-627-5558

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL EDWARD EVANS
Credential	:	D.C.
Telephone Number	:	909-627-6884

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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