Provider Demographics
NPI:1346303831
Name:ATLAS ORTHOGONAL CHIROPRACTIC
Entity Type:Organization
Organization Name:ATLAS ORTHOGONAL CHIROPRACTIC
Other - Org Name:MITCHELL BRADDON, D.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-998-7774
Mailing Address - Street 1:7828 HICKORY FLAT HWY. #130
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3631
Mailing Address - Country:US
Mailing Address - Phone:770-998-7774
Mailing Address - Fax:
Practice Address - Street 1:7828 HICKORY FLAT HWY STE 130
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6578
Practice Address - Country:US
Practice Address - Phone:770-998-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO004968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA543858OtherBLUE CROSS BLUE SHIELD
GA543858OtherBLUE CROSS BLUE SHIELD