Provider Demographics
NPI:1477262962
Name:ATLANTIC WAY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ATLANTIC WAY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-400-6282
Mailing Address - Street 1:717 BONNIE CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4123
Mailing Address - Country:US
Mailing Address - Phone:321-400-6282
Mailing Address - Fax:321-333-5335
Practice Address - Street 1:2074 MEADOWLANE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4950
Practice Address - Country:US
Practice Address - Phone:321-400-6282
Practice Address - Fax:321-333-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center