1780176628 NPI number — EVOLUTION CHIROPRACTIC & WELLNESS PLLC

Table of content: DENISE ARLEEN CHANEY REGISTERED NURSE (NPI 1831656461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780176628 NPI number — EVOLUTION CHIROPRACTIC & WELLNESS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVOLUTION CHIROPRACTIC & WELLNESS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780176628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48014-0159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-673-3044
Provider Business Mailing Address Fax Number:
810-729-6025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4260 M-53
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
ALMONT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-673-3044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
COUSINEAU
Authorized Official First Name:
BRIANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
810-673-3044

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301010604 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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