Provider Demographics
NPI:1265030589
Name:ATLAS ALIGNED LLC
Entity Type:Organization
Organization Name:ATLAS ALIGNED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:M
Authorized Official - Last Name:FEDEWA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-393-4709
Mailing Address - Street 1:420 N CHESTNUT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1109
Mailing Address - Country:US
Mailing Address - Phone:920-848-2392
Mailing Address - Fax:920-239-8135
Practice Address - Street 1:420 N CHESTNUT AVE STE B
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1109
Practice Address - Country:US
Practice Address - Phone:920-848-2392
Practice Address - Fax:920-239-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty