Provider Demographics
NPI:1114186640
Name:ATLAS CHIROPRACTIC HEALTH CENTER PC
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:517-548-2560
Mailing Address - Street 1:2739 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-4513
Mailing Address - Country:US
Mailing Address - Phone:517-548-2560
Mailing Address - Fax:517-548-0771
Practice Address - Street 1:2739 E GRAND RIVER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-4513
Practice Address - Country:US
Practice Address - Phone:517-548-2560
Practice Address - Fax:517-548-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OD752670OtherBLUE CROSS BLUE SHIELD
MI2910079Medicaid
MIU33205OtherUPIN
MIU33205OtherUPIN