MEDICARE: DR. TROY DEVON 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	CHIR007979	GA
2	111N00000X	Chiropractor	2004017332	MO

General Provider Information

NPI Number	:	1942223649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY DEVON EVANS D.C.

Provider Business Mailing Address
First Line	:	P.O. BOX 384
Second Line	:
City	:	STOCKTON
State	:	MO
Zip	:	65785-0384
Country	:	US
Telephone Number	:	417-808-0225
Fax Number	:	417-808-0225

Provider Business Practice Location Address
First Line	:	107 W HWY 32
Second Line	:	SUITE D
City	:	STOCKTON
State	:	MO
Zip	:	65785-0384
Country	:	US
Telephone Number	:	417-808-0225
Fax Number	:	417-808-0225

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/17/2011

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