Provider Demographics
NPI:1720328941
Name:ATLAS CHIROPRACTIC OF WINNER, LLC
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC OF WINNER, LLC
Other - Org Name:ATLAS CHIROPRACTIC OF WINNER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLUWEIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-842-1588
Mailing Address - Street 1:210 S. MAIN ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580
Mailing Address - Country:US
Mailing Address - Phone:605-842-1588
Mailing Address - Fax:605-842-1378
Practice Address - Street 1:210 S. MAIN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580
Practice Address - Country:US
Practice Address - Phone:605-842-1588
Practice Address - Fax:605-842-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty