Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 13891 | TX |
NPI | 1144785130 |
---|---|
Provider Name | Jason Michael Evans |
First Address | Allen, TX 75013-4955 |
Second Address | Allen, TX 75013-4955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 05/02/2019 |