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General NPI Number Information
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NPI Number | 1417296427
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Entity Type | Organization
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Legal Business Name | EVOLVE REHABILITATION & WELLNESS, LLC
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 2735 HARTLAND RD SUITE 100
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City | FALLS CHURCH
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State | VA
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Zip | 22043-3542
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Country | US
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Telephone | 202-440-2939
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Fax |
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Provider Business Mailing Address
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Address Line | 4173 VERNOY HILLS RD
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City | FAIRFAX
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State | VA
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Zip | 22033-4395
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Country | US
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Telephone | 202-440-2939
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ALI PAJOUHESH
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Credential |
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Telephone | 202-440-2939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 0104557003
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License Number State | VA
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