Provider Demographics
NPI:1598311987
Name:EVOLUTION WELLNESS
Entity Type:Organization
Organization Name:EVOLUTION WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-577-5595
Mailing Address - Street 1:4640 E 17TH AVENUE PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1126
Mailing Address - Country:US
Mailing Address - Phone:415-690-6699
Mailing Address - Fax:
Practice Address - Street 1:3500 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1813
Practice Address - Country:US
Practice Address - Phone:720-577-5595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty