Provider Demographics
NPI:1093900904
Name:ATLAS CHIROPRACTIC & WELLNESS GROUP
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC & WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-802-9977
Mailing Address - Street 1:3220 S GILBERT RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-5109
Mailing Address - Country:US
Mailing Address - Phone:480-802-9977
Mailing Address - Fax:
Practice Address - Street 1:3220 S. GILBERT RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-802-9977
Practice Address - Fax:480-802-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty