Provider Demographics
NPI:1609146463
Name:EVA MANAGEMENT LLC
Entity Type:Organization
Organization Name:EVA MANAGEMENT LLC
Other - Org Name:CROSSROADS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:V
Authorized Official - Last Name:AZHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-625-4655
Mailing Address - Street 1:7751 SUNBLEST BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7751 SUNBLEST BLVD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1173
Practice Address - Country:US
Practice Address - Phone:317-625-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002567A261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service