Provider Demographics
NPI:1326367632
Name:EVOLUTION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EVOLUTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAHOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-481-0373
Mailing Address - Street 1:10919 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4262
Mailing Address - Country:US
Mailing Address - Phone:360-481-0373
Mailing Address - Fax:
Practice Address - Street 1:10919 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4262
Practice Address - Country:US
Practice Address - Phone:360-481-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60114798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty