=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891346227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVOLVE HEALTH CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2019
-----------------------------------------------------
Last Update Date | 09/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1219 N SUMTER BLVD
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34286-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-500-4507
-----------------------------------------------------
Fax | 941-257-5129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1219 N SUMTER BLVD
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34286-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-500-4507
-----------------------------------------------------
Fax | 941-257-5129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEFANIE ASCHER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 941-500-4507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------