Provider Demographics
NPI:1508224247
Name:EVOLUTION SPINE & SPORTS THERAPY, LLC
Entity Type:Organization
Organization Name:EVOLUTION SPINE & SPORTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-307-2201
Mailing Address - Street 1:922 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2706
Mailing Address - Country:US
Mailing Address - Phone:224-307-2201
Mailing Address - Fax:224-304-0881
Practice Address - Street 1:922 NOYES ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2706
Practice Address - Country:US
Practice Address - Phone:224-307-2201
Practice Address - Fax:224-304-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38.012838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty