Provider Demographics
NPI:1902565518
Name:EVOLVE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:EVOLVE HEALTH AND WELLNESS LLC
Other - Org Name:EVOLVE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-456-3509
Mailing Address - Street 1:1715 IRON HORSE DR STE 145
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9756
Mailing Address - Country:US
Mailing Address - Phone:585-456-3509
Mailing Address - Fax:
Practice Address - Street 1:1715 IRON HORSE DR STE 145
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9756
Practice Address - Country:US
Practice Address - Phone:585-456-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty