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General NPI Number Information
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NPI Number | 1780176628
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Entity Type | Organization
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Legal Business Name | EVOLUTION CHIROPRACTIC & WELLNESS PLLC
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 4260 M-53 SUITE 110
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City | ALMONT
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State | MI
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Zip | 48003
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Country | US
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Telephone | 810-673-3044
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | CAPAC
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State | MI
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Zip | 48014-0159
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Country | US
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Telephone | 810-673-3044
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Fax | 810-729-6025
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Authorized Official
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Title or Position | OWNER
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Name | BRIANNA COUSINEAU
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Credential | DC
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Telephone | 810-673-3044
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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 | 2301010604
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License Number State | MI
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