Provider Demographics
NPI:1255684866
Name:EVOLVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EVOLVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MURCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-340-1104
Mailing Address - Street 1:144 MORGAN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5433
Mailing Address - Country:US
Mailing Address - Phone:203-340-1104
Mailing Address - Fax:
Practice Address - Street 1:144 MORGAN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5433
Practice Address - Country:US
Practice Address - Phone:203-340-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty