Provider Demographics
NPI:1942223649
Name:EVANS, TROY DEVON (DC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:DEVON
Last Name:EVANS
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:P.O. BOX 384
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-0384
Mailing Address - Country:US
Mailing Address - Phone:417-808-0225
Mailing Address - Fax:417-808-0225
Practice Address - Street 1:107 W HWY 32
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-0384
Practice Address - Country:US
Practice Address - Phone:417-808-0225
Practice Address - Fax:417-808-0225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007979111N00000X
MO2004017332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV07175Medicare UPIN
GA35ZCJNVMedicare ID - Type Unspecified