Organization
EVOLUTION CHIROPRACTIC AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY PAYNE DC (PRESIDENT)
(208) 917-2928
Entity
Organization
Contact information
Practice address
947 E WINDING CREEK DR STE 200, EAGLE, ID 83616-7231
(503) 756-5317
Mailing address
947 E WINDING CREEK DR STE 200, EAGLE, ID 83616-7231
(503) 756-5317
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID015388
—
ID
Enumeration date
12/07/2021
Last updated
12/07/2021
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