Provider Demographics
NPI:1821763434
Name:EVOLVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EVOLVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIRZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-330-1100
Mailing Address - Street 1:290 MARKET ST UNIT 611
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1685
Mailing Address - Country:US
Mailing Address - Phone:763-330-1100
Mailing Address - Fax:
Practice Address - Street 1:11820 ULYSSES ST NE
Practice Address - Street 2:SUITE 140
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434
Practice Address - Country:US
Practice Address - Phone:763-330-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty