Individual
EVAN SOUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1749 N WELLS ST, CHICAGO, IL 60614-5877
(312) 440-9646
(773) 337-9106
Mailing address
1749 N WELLS ST, CHICAGO, IL 60614-5877
(312) 440-9646
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038013891
IL
111N00000X
Chiropractor
038013891
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03803891
IL STATE PROVIDER LICENSE
IL
Enumeration date
08/30/2022
Last updated
08/31/2022
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