Provider Demographics
NPI:1114331030
Name:ATLAS CHIROPRACTIC CENTERS INC
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-903-3649
Mailing Address - Street 1:811 S PERRYVILLE RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-4323
Mailing Address - Country:US
Mailing Address - Phone:779-423-2044
Mailing Address - Fax:779-423-2045
Practice Address - Street 1:811 S PERRYVILLE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4323
Practice Address - Country:US
Practice Address - Phone:779-423-2044
Practice Address - Fax:779-423-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty