Provider Demographics
NPI:1154763829
Name:ATLAS CHIROPRACTIC & WELLNESS, PC
Entity type:Organization
Organization Name:ATLAS CHIROPRACTIC & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-488-0410
Mailing Address - Street 1:PO BOX 2068
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29342-2068
Mailing Address - Country:US
Mailing Address - Phone:864-488-0410
Mailing Address - Fax:864-488-2216
Practice Address - Street 1:115 SOUTHPORT RD STE B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3814
Practice Address - Country:US
Practice Address - Phone:864-804-6612
Practice Address - Fax:864-488-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty