Provider Demographics
NPI:1588827752
Name:ATLANTIC NUTRITION CENTERS LLC
Entity Type:Organization
Organization Name:ATLANTIC NUTRITION CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EPITROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHD
Authorized Official - Phone:386-274-2520
Mailing Address - Street 1:1663 NORTH CLYDE MORRIS BLVD.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-274-2520
Mailing Address - Fax:386-274-2521
Practice Address - Street 1:1663 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:386-274-2520
Practice Address - Fax:386-274-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDP1865OtherMEDICARE RAILROAD
FL89058OtherBCBS
FL89058OtherBCBS