Provider Demographics
NPI:1447585682
Name:ATLANTIC HEALTH SOLUTIONS, INC
Entity Type:Organization
Organization Name:ATLANTIC HEALTH SOLUTIONS, INC
Other - Org Name:ATLANTIC CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:AFGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-527-8003
Mailing Address - Street 1:840 DUNLAWTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4224
Mailing Address - Country:US
Mailing Address - Phone:386-527-8003
Mailing Address - Fax:386-492-4887
Practice Address - Street 1:840 DUNLAWTON AVE STE B
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4224
Practice Address - Country:US
Practice Address - Phone:386-527-8003
Practice Address - Fax:386-492-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002888700Medicaid
FLDU925ZMedicare UPIN