Provider Demographics
NPI:1629580253
Name:HOLISTIC FAMILY HEALTHCARE & SPA, LLC
Entity Type:Organization
Organization Name:HOLISTIC FAMILY HEALTHCARE & SPA, LLC
Other - Org Name:EVANS FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARLENA
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-992-7604
Mailing Address - Street 1:420 PILCHARD CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-5266
Mailing Address - Country:US
Mailing Address - Phone:843-992-7604
Mailing Address - Fax:843-799-4784
Practice Address - Street 1:2213 W PALMETTO ST UNIT D
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3909
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty