Mark Eavenson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Practice address

3986 Maryville Rd
Granite City, IL 62040-4191

Phone

(618) 797-0618

Fax

(618) 797-2243

NPI assigned

Mar 20, 2006

Last updated

Jul 19, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Multi-Care Specialists SC

  • Family Medicine Physician
  • Granite City, IL
  • NPI 1811087604

  Chiropractor

  Medicare reassignment NPD

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184803200000",
    "number": "1629037536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3986 MARYVILLE RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404191",
            "telephone_number": "618-797-0618",
            "fax_number": "618-797-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3986 MARYVILLE RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404191",
            "telephone_number": "618-797-0618",
            "fax_number": "618-797-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAVENSON",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2007-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Yogendra a. Shah, MD. SC
• Blake W Dugger, D.C.
• Bonnie Durbin
• Dynamic Spine and Joint Center LLC
• Ashley Lauren Eavenson, D.C.
• Tabitha Robin Ellsworth, D.C.
• Emergency Department Associates, P.C.
• Lori Epley, LMSW
• Evercare at Stearns LLC
• Evercare of Granite City LLC

• Chiropractor in Granite City, IL
• Providers in Granite City, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; 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.