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General NPI Number Information
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NPI Number | 1386184273
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Entity Type | Organization
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Legal Business Name | EVOLUTION SPINE & WELLNESS LLC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 336 MAIN ST
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5540
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Country | US
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Telephone | 301-828-8229
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Fax |
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Provider Business Mailing Address
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Address Line | 6082 CEDAR WOOD DR
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City | COLUMBIA
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State | MD
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Zip | 21044-3675
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Country | US
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Telephone | 301-661-7950
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. REED FREDERICK NEUBAUM
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Credential | DC
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Telephone | 301-661-7950
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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 | C15129
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License Number State | MD
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