Provider Demographics
NPI:1144593385
Name:ATLAS 1ST HEALTH & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ATLAS 1ST HEALTH & WELLNESS CENTER, LLC
Other - Org Name:UPPER CERVICAL HEALTH CENTERS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-622-4447
Mailing Address - Street 1:1600 W EAU GALLIE BLVD
Mailing Address - Street 2:STE. #104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4149
Mailing Address - Country:US
Mailing Address - Phone:321-622-4447
Mailing Address - Fax:
Practice Address - Street 1:1600 W EAU GALLIE BLVD
Practice Address - Street 2:STE. #104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4149
Practice Address - Country:US
Practice Address - Phone:321-622-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1659527901OtherINDIVIDUAL NPI