Provider Demographics
NPI:1053363051
Name:EVERHART, DARRELL RAY (DC)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:RAY
Last Name:EVERHART
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 1:204 SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4217
Mailing Address - Country:US
Mailing Address - Phone:337-829-1030
Mailing Address - Fax:337-828-7958
Practice Address - Street 1:1305 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-4321
Practice Address - Country:US
Practice Address - Phone:337-828-0467
Practice Address - Fax:337-828-7958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG9566OtherBCBS
LA7414664OtherAETNA
LA7414664OtherAETNA
LA4H310D353Medicare ID - Type Unspecified