Active NPI
Keith Alan Evans, D.C.
- Chiropractor
- Beaumont, TX
National Provider Identifier
1992704688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5213
- Practice address
- 4220 Treadway Rd
Beaumont, TX 77706-7105 - Phone
- (409) 833-5600
- Fax
- (409) 833-2111
- NPI assigned
- Jul 15, 2005
- Reactivated
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5213 | TX | Primary |
Addresses
Primary practice location
4220 Treadway Rd
Beaumont, TX 77706-7105
Mailing address
9898 Colonnade Blvd
#17202
San Antonio, TX 78230-2247
Phone (409) 781-1668
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8F0631 | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5213 | TX | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276646400000",
"number": "1992704688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9898 COLONNADE BLVD",
"address_2": "#17202",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782302247",
"telephone_number": "409-781-1668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4220 TREADWAY RD",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777067105",
"telephone_number": "409-833-5600",
"fax_number": "409-833-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "KEITH",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-15",
"last_updated": "2010-06-16",
"deactivation_date": "2006-03-17",
"reactivation_date": "2006-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "5213",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8F0631",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.