Provider Demographics
NPI:1396428355
Name:ATLAS CHIROPRACTIC OF FORT WAYNE LLC
Entity type:Organization
Organization Name:ATLAS CHIROPRACTIC OF FORT WAYNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:DARR
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-603-8605
Mailing Address - Street 1:5113 N BEND DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1753
Mailing Address - Country:US
Mailing Address - Phone:260-399-9020
Mailing Address - Fax:260-399-9020
Practice Address - Street 1:5113 N BEND DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1753
Practice Address - Country:US
Practice Address - Phone:260-399-9020
Practice Address - Fax:260-399-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center