Healthcare Provider Details

I. General information

NPI: 1992647994
Provider Name (Legal Business Name): EVOLVE CHIROPRACTIC AND WELLNESS CENTER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30100 TELEGRAPH RD STE 179
BINGHAM FARMS MI
48025-4514
US

IV. Provider business mailing address

30100 TELEGRAPH RD STE 179
BINGHAM FARMS MI
48025-4514
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-7278
  • Fax:
Mailing address:
  • Phone: 248-792-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: RANY MOUSA
Title or Position: OWNER
Credential:
Phone: 248-792-7278