Provider Demographics
NPI:1366154114
Name:BANDY, EVAN RAY (DC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:RAY
Last Name:BANDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7047 S D ST STE A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-6131
Mailing Address - Country:US
Mailing Address - Phone:253-471-8986
Mailing Address - Fax:253-471-8987
Practice Address - Street 1:802 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6107
Practice Address - Country:US
Practice Address - Phone:253-859-2940
Practice Address - Fax:253-813-8484
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61286101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor