Provider Demographics
NPI:1386184273
Name:EVOLUTION SPINE & WELLNESS LLC
Entity Type:Organization
Organization Name:EVOLUTION SPINE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:REED
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:NEUBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-661-7950
Mailing Address - Street 1:6082 CEDAR WOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3675
Mailing Address - Country:US
Mailing Address - Phone:301-661-7950
Mailing Address - Fax:
Practice Address - Street 1:336 MAIN ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5540
Practice Address - Country:US
Practice Address - Phone:301-828-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC15129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty