Provider Demographics
NPI:1629427398
Name:ATLAS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-663-7060
Mailing Address - Street 1:1322 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1921
Mailing Address - Country:US
Mailing Address - Phone:517-281-4566
Mailing Address - Fax:517-663-7061
Practice Address - Street 1:1322 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1921
Practice Address - Country:US
Practice Address - Phone:517-281-4566
Practice Address - Fax:517-663-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1710924360111N00000X
MI1093752644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B350300OtherBLUE CROSS BLUE SHIELD
MI1006145OtherMCLAREN
MI10006146OtherMCLAREN
MI3356697Medicaid
MI950B350280OtherBLUE CROSS BLUE SHIELD
MIOM33440Medicare UPIN
MIOM3287OMedicare UPIN