Provider Demographics
NPI:1891030631
Name:CHIROPRACTIC EVOLVED LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC EVOLVED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKOLAS
Authorized Official - Middle Name:RAMONE
Authorized Official - Last Name:CHILLIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-420-7073
Mailing Address - Street 1:7164 HACKS CROSS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3907
Mailing Address - Country:US
Mailing Address - Phone:662-420-7073
Mailing Address - Fax:662-420-7581
Practice Address - Street 1:7164 HACKS CROSS RD STE 110
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3907
Practice Address - Country:US
Practice Address - Phone:662-420-7073
Practice Address - Fax:662-420-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty