Provider Demographics
NPI:1942329578
Name:EVANS, CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:146 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2920
Mailing Address - Country:US
Mailing Address - Phone:802-229-2299
Mailing Address - Fax:802-229-4080
Practice Address - Street 1:146 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2920
Practice Address - Country:US
Practice Address - Phone:802-229-2299
Practice Address - Fax:802-229-4080
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor