Provider Demographics
NPI:1326588476
Name:EVAN P WELFARE
Entity Type:Organization
Organization Name:EVAN P WELFARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WELFARE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-415-6188
Mailing Address - Street 1:176 HOLLYWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7816
Mailing Address - Country:US
Mailing Address - Phone:904-415-6188
Mailing Address - Fax:
Practice Address - Street 1:1820 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4913
Practice Address - Country:US
Practice Address - Phone:904-264-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty