NPIMap

Organization Active NPI

Eliesha R Evans DC SC

  • Chiropractor
  • New Berlin, WI
National Provider Identifier
1154631349
Registry record updated Oct 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2880 Issued in WI
Legal business name
ELIESHA R EVANS DC SC
Practice address
15720W National Ave
New Berlin, WI 53151-5119
Phone
(262) 785-5515
Fax
(262) 785-5525
NPI assigned
Oct 21, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eliesha Ruth Evans, D.C.NPI 1023327384
Title
President/Owner
Phone
(262) 785-5515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2880 WI Primary

Addresses

Primary practice location

15720W National Ave
New Berlin, WI 53151-5119

Mailing address

15720W National Ave
New Berlin, WI 53151-5119
Phone (262) 785-5515

Other names 1

  • EVANS CHIROPRACTIC HEALTH CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101217000398 WI Part B Supplier - Clinic/Group Practice 7911195953 Receives reassigned benefits from 1 practitioner
Practice locations: New Berlin, WI

National Provider Directory

National Provider Directory

Locations

15720 W National Ave
New Berlin, WI 53151
Phone (262) 785-5515

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1154631349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15720W NATIONAL AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531515119",
            "telephone_number": "262-785-5515",
            "fax_number": "262-785-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15720W NATIONAL AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531515119",
            "telephone_number": "262-785-5515",
            "fax_number": "262-785-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIESHA R EVANS DC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ELIESHA",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "262-785-5515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVANS CHIROPRACTIC HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Berlin, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.