Provider Demographics
NPI:1699134825
Name:CHIROEVOLUTION LLC
Entity type:Organization
Organization Name:CHIROEVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORA
Authorized Official - Middle Name:ALYCE GENTRY
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-228-0373
Mailing Address - Street 1:1001 WEXFORD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9214
Mailing Address - Country:US
Mailing Address - Phone:412-228-0373
Mailing Address - Fax:
Practice Address - Street 1:1001 WEXFORD PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9214
Practice Address - Country:US
Practice Address - Phone:412-228-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty