Provider Demographics
NPI:1457494841
Name:ATLAS CHIROPRACTIC OFFICE LLC
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SZATALOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-782-8077
Mailing Address - Street 1:W264N7020 THOUSAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2426
Mailing Address - Country:US
Mailing Address - Phone:414-839-6966
Mailing Address - Fax:
Practice Address - Street 1:333 BISHOPS WAY STE 144
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6226
Practice Address - Country:US
Practice Address - Phone:262-782-8077
Practice Address - Fax:262-782-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1827-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI75264Medicare ID - Type Unspecified