Provider Demographics
NPI:1023597705
Name:EVOLVE CHIROPRACTIC
Entity type:Organization
Organization Name:EVOLVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUCHENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-996-0992
Mailing Address - Street 1:19199 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2508
Mailing Address - Country:US
Mailing Address - Phone:586-791-5555
Mailing Address - Fax:
Practice Address - Street 1:19199 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035
Practice Address - Country:US
Practice Address - Phone:586-791-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty