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General NPI Number Information
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NPI Number | 1588829782
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Entity Type | Organization
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Legal Business Name | DR. EVANS EXCLUSIVE HEALTH & WELLNESS
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 1000 E 41ST ST STE 915
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City | AUSTIN
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State | TX
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Zip | 78751-4808
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Country | US
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Telephone | 210-900-6027
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 LOCKHILL SELMA RD STE 240
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City | SAN ANTONIO
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State | TX
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Zip | 78230-3007
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Country | US
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Telephone | 210-446-3097
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER PRESIDENT
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Name | DR. MICHELLE ATHALIE EVANS
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Credential | D.C.
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Telephone | 210-900-6027
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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 | 5925
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License Number State | TX
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