Provider Demographics
NPI:1952633745
Name:ATLAS CHIROPRACTIC OF CARY, PLLC
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC OF CARY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:ELLWANGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:919-345-9722
Mailing Address - Street 1:6936 WADE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8535
Mailing Address - Country:US
Mailing Address - Phone:919-345-9722
Mailing Address - Fax:
Practice Address - Street 1:6936 WADE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8535
Practice Address - Country:US
Practice Address - Phone:919-345-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456988Medicare PIN