Provider Demographics
NPI:1538149133
Name:GOLD, EVAN (DC)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:GOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HARTFORD TPKE
Mailing Address - Street 2:STE G2
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:STE G2
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4761
Practice Address - Country:US
Practice Address - Phone:860-643-1668
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTTOS020OtherOXFORD
CT061130742-001OtherCIGNA
DECT00474OtherLANDMARK
CT42157OtherAETNA
CT0530770OtherAETNA US HEALTH CARE
CT4404149OtherUNITED HEALTH CARE
CT050000474CT01OtherANTHEM BLUE CROSS
CT0530770OtherAETNA US HEALTH CARE
DECT00474OtherLANDMARK