MEDICARE: EVOLVE PERFORMANCE & WELLNESS A DIAZ CHIROPRACTIC PROFESSIONAL COR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1366138893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE PERFORMANCE & WELLNESS A DIAZ CHIROPRACTIC PROFESSIONAL COR

Provider Business Mailing Address
First Line	:	PO BOX 4558
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95604-4558
Country	:	US
Telephone Number	:	530-488-0188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 GRASS VALLEY HWY STE B
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95602-2002
Country	:	US
Telephone Number	:	530-488-0188
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIELLE ELIZABETH DIAZ
Credential	:	DC
Telephone Number	:	530-488-0188

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	05/04/2023

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Directions to “EVOLVE PERFORMANCE & WELLNESS A DIAZ CHIROPRACTIC PROFESSIONAL COR ” Practice Location

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