Provider Demographics
NPI:1326216391
Name:ATLAS SPINE CENTER LLC
Entity Type:Organization
Organization Name:ATLAS SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FROERER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-833-0302
Mailing Address - Street 1:1919 E. MCKELLIPS RD.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2855
Mailing Address - Country:US
Mailing Address - Phone:480-833-0302
Mailing Address - Fax:480-833-0904
Practice Address - Street 1:1919 E. MCKELLIPS RD.
Practice Address - Street 2:SUITE 106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2855
Practice Address - Country:US
Practice Address - Phone:480-833-0302
Practice Address - Fax:480-833-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7548111N00000X
AZ1472207Q00000X
AZ4477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty