Provider Demographics
NPI:1255752507
Name:ATLAS ADVANTAGE CHIROPRACTIC L.L.C.
Entity type:Organization
Organization Name:ATLAS ADVANTAGE CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-309-4316
Mailing Address - Street 1:9766 FALLON AVE NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-4588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9766 FALLON AVE NE
Practice Address - Street 2:SUITE 104
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4588
Practice Address - Country:US
Practice Address - Phone:320-309-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty