Provider Demographics
NPI:1639691835
Name:EVERGREEN FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:EVERGREEN FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-297-6270
Mailing Address - Street 1:14 E BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2402
Mailing Address - Country:US
Mailing Address - Phone:864-297-6270
Mailing Address - Fax:
Practice Address - Street 1:14 E BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2402
Practice Address - Country:US
Practice Address - Phone:864-297-6270
Practice Address - Fax:864-509-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty