Provider Demographics
NPI:1033488168
Name:ATRIUM CHIROPRACTIC AND REHAB, INC.
Entity Type:Organization
Organization Name:ATRIUM CHIROPRACTIC AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-599-8800
Mailing Address - Street 1:3900 NW 79TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:305-599-8800
Mailing Address - Fax:305-599-8877
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:305-599-8800
Practice Address - Fax:305-599-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty