Provider Demographics
NPI:1598842080
Name:ATKISSON, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:ATKISSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 OCEAN HEIGHTS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7708
Mailing Address - Country:US
Mailing Address - Phone:609-653-6400
Mailing Address - Fax:609-653-8347
Practice Address - Street 1:3110 OCEAN HEIGHTS AVE STE 2
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7708
Practice Address - Country:US
Practice Address - Phone:609-653-6400
Practice Address - Fax:609-653-8347
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00284400111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45736Medicare UPIN
NJAT536571Medicare ID - Type Unspecified