Provider Demographics
NPI:1003665456
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:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER LINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-415-0277
Mailing Address - Street 1:302 N 168TH CIR STE 208
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-4089
Mailing Address - Country:US
Mailing Address - Phone:402-415-0277
Mailing Address - Fax:
Practice Address - Street 1:302 N 168TH CIR STE 208
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-4089
Practice Address - Country:US
Practice Address - Phone:402-415-0277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty