Provider Demographics
NPI:1710059126
Name:ATLAS PAIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:ATLAS PAIN INSTITUTE, LLC
Other - Org Name:ATLAS CHIROPRACTIC AND SPINAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-332-2777
Mailing Address - Street 1:85 LOOP 150 W
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3930
Mailing Address - Country:US
Mailing Address - Phone:512-332-2777
Mailing Address - Fax:512-332-2701
Practice Address - Street 1:85 LOOP 150 W
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3930
Practice Address - Country:US
Practice Address - Phone:512-332-2777
Practice Address - Fax:512-332-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW531OtherBLUE CROSS BLUE SHIELD
TX00X389Medicare PIN
TX8AW531OtherBLUE CROSS BLUE SHIELD