Provider Demographics
NPI:1114066917
Name:ATLAS SPECIFIC CHIROPRACTIC
Entity Type:Organization
Organization Name:ATLAS SPECIFIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-283-6929
Mailing Address - Street 1:640 DENBIGH BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4485
Mailing Address - Country:US
Mailing Address - Phone:757-283-6929
Mailing Address - Fax:757-283-6931
Practice Address - Street 1:640 DENBIGH BLVD STE 4
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4485
Practice Address - Country:US
Practice Address - Phone:757-283-6929
Practice Address - Fax:757-283-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W657A02OtherMEDICARE DR. E. MIERZEJEW
VA11501696OtherCAQH DR. E. MIERZEJEWSKI
VA1477540730OtherNPI DR. E. MIERZEJEWSKI
VA11281024OtherCAQH DR. RENATA KOWAL
VA1770576738OtherNPI FOR DR. R. KOWAL
VAU99608OtherUPIN DR. E. MIERZEJEWSKI
VA184653OtherBCBS DR. R. KOWAL
VA00W658A01OtherMEDICARE DR. R. KOWAL
VA1770576738OtherNPI FOR DR. R. KOWAL
VA00W657A02OtherMEDICARE DR. E. MIERZEJEW