Provider Demographics
NPI:1710392691
Name:ATLAS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC, INC.
Other - Org Name:ATLAS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-466-1111
Mailing Address - Street 1:185 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3032
Mailing Address - Country:US
Mailing Address - Phone:203-466-1111
Mailing Address - Fax:203-468-9684
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3032
Practice Address - Country:US
Practice Address - Phone:203-466-1111
Practice Address - Fax:203-468-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2018-02-27
Deactivation Date:2014-07-07
Deactivation Code:
Reactivation Date:2018-02-27
Provider Licenses
StateLicense IDTaxonomies
CT001459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty