Provider Demographics
NPI:1750043592
Name:EVOLVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EVOLVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-661-0573
Mailing Address - Street 1:2031 SHADOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4548
Mailing Address - Country:US
Mailing Address - Phone:812-661-0573
Mailing Address - Fax:
Practice Address - Street 1:3901 ROSWELL RD STE 208
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8810
Practice Address - Country:US
Practice Address - Phone:770-509-9717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty