Provider Demographics
NPI:1023327384
Name:EVANS, ELIESHA RUTH (DC)
Entity type:Individual
Prefix:DR
First Name:ELIESHA
Middle Name:RUTH
Last Name:EVANS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIESHA
Other - Middle Name:RUTH
Other - Last Name:GATZKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:15720 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5119
Mailing Address - Country:US
Mailing Address - Phone:262-785-5515
Mailing Address - Fax:
Practice Address - Street 1:15720 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5119
Practice Address - Country:US
Practice Address - Phone:262-785-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor