Provider Demographics
NPI:1275850943
Name:DR DEBRA PAVLOVIC PA ATLAS WELLNESS OF LAKELAND
Entity Type:Organization
Organization Name:DR DEBRA PAVLOVIC PA ATLAS WELLNESS OF LAKELAND
Other - Org Name:ATLAS WELLNESS OF LAKELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PAVLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-603-9355
Mailing Address - Street 1:1507 LAKELAND HILLS BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3205
Mailing Address - Country:US
Mailing Address - Phone:863-603-9355
Mailing Address - Fax:863-603-0120
Practice Address - Street 1:1507 LAKELAND HILLS BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3205
Practice Address - Country:US
Practice Address - Phone:863-603-9355
Practice Address - Fax:863-603-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty