Provider Demographics
NPI:1083801211
Name:EVVDC, PC
Entity Type:Organization
Organization Name:EVVDC, PC
Other - Org Name:INNOVATIVE HEALTH AND WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:VANVELDHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FNP
Authorized Official - Phone:214-295-9671
Mailing Address - Street 1:4001 MCEWEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5021
Mailing Address - Country:US
Mailing Address - Phone:214-295-9671
Mailing Address - Fax:972-432-5139
Practice Address - Street 1:4001 MCEWEN RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5021
Practice Address - Country:US
Practice Address - Phone:214-295-9671
Practice Address - Fax:972-432-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty