Provider Demographics
NPI:1033422100
Name:ATLANTIC NUTRITION CENTERS, LLC
Entity Type:Organization
Organization Name:ATLANTIC NUTRITION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EPITROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHD
Authorized Official - Phone:386-274-2520
Mailing Address - Street 1:2441 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5615
Mailing Address - Country:US
Mailing Address - Phone:386-274-2520
Mailing Address - Fax:386-274-2521
Practice Address - Street 1:145 CYPRESS POINT PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8426
Practice Address - Country:US
Practice Address - Phone:386-274-2520
Practice Address - Fax:386-274-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty