Healthcare Provider Details

I. General information

NPI: 1316884729
Provider Name (Legal Business Name): EVOKE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 W COLORADO AVE STE 15
COLORADO SPRINGS CO
80904-3073
US

IV. Provider business mailing address

3103 HUDSON ST
COLORADO SPRINGS CO
80910-2942
US

V. Phone/Fax

Practice location:
  • Phone: 719-323-4691
  • Fax:
Mailing address:
  • Phone: 719-323-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOE OLIVAREZ
Title or Position: FOUNDER
Credential:
Phone: 718-323-4691