Provider Demographics
NPI:1881230746
Name:EVOLVE CHIROPRACTIC AND REHAB LLC
Entity Type:Organization
Organization Name:EVOLVE CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-520-4158
Mailing Address - Street 1:503 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-2323
Mailing Address - Country:US
Mailing Address - Phone:605-690-9045
Mailing Address - Fax:
Practice Address - Street 1:220 S CLIFF AVE STE 102
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2487
Practice Address - Country:US
Practice Address - Phone:605-520-4158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty