Provider Demographics
NPI:1740246842
Name:ATKINSON CLINIC OF CHIROPRACTIC
Entity type:Organization
Organization Name:ATKINSON CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-475-8669
Mailing Address - Street 1:7970 CLARK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118
Mailing Address - Country:US
Mailing Address - Phone:734-475-8669
Mailing Address - Fax:734-475-0304
Practice Address - Street 1:7970 CLARK LAKE RD
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-475-8669
Practice Address - Fax:734-475-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1359789Medicaid
MI95OH16313OtherBLUE CROSS BS OF MI
MIOM81430Medicare ID - Type Unspecified
MI1359789Medicaid