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General NPI Number Information
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NPI Number | 1063908218
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Entity Type | Organization
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Legal Business Name | EVOLVE CHIROPRACTIC WOODSTOCK PLLC
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 2440 LAKE SHORE DRIVE
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City | WOODSTOCK
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State | IL
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Zip | 60098-2980
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Country | US
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Telephone | 815-338-9150
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Fax |
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Provider Business Mailing Address
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Address Line | 10705 RUTH RD
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City | HUNTLEY
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State | IL
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Zip | 60142-7156
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Country | US
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Telephone | 815-338-9150
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DR. RYAN FELDE
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Credential |
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Telephone | 847-345-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-012415
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License Number State | IL
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