Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0104557642 | VA |
N | 111NS0005X | Chiropractic Sports Physician | 9297663-1202 | UT |
NPI | 1023409059 |
---|---|
Provider Name | Dr. Sarah Wilson Evans |
First Address | Alexandria, VA 22314 |
Second Address | Alexandria, VA 22314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2015 |
Last Update Date | 13/09/2021 |