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General NPI Number Information
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NPI Number | 1326367632
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Entity Type | Organization
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Legal Business Name | EVOLUTION CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 10919 CANYON RD E
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City | PUYALLUP
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State | WA
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Zip | 98373-4262
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Country | US
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Telephone | 360-481-0373
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Fax |
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Provider Business Mailing Address
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Address Line | 10919 CANYON RD E
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City | PUYALLUP
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State | WA
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Zip | 98373-4262
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Country | US
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Telephone | 360-481-0373
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JAMES C. LAHOE
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Credential | DC
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Telephone | 360-481-0373
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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 | CH60114798
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License Number State | WA
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