Healthcare Provider Details

I. General information

NPI: 1417868191
Provider Name (Legal Business Name): EVERWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24351 ARCOLA MILLS DR
ALDIE VA
20105-2065
US

IV. Provider business mailing address

24351 ARCOLA MILLS DR
ALDIE VA
20105-2065
US

V. Phone/Fax

Practice location:
  • Phone: 571-206-0123
  • Fax:
Mailing address:
  • Phone: 571-206-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FOX EVERGREEN
Title or Position: DOCTOR
Credential: DC
Phone: 562-269-8316