Provider Demographics
NPI:1740489095
Name:ATLAS CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:ATLAS CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCEANAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC CN
Authorized Official - Phone:610-982-5966
Mailing Address - Street 1:2 QUARRY LANE
Mailing Address - Street 2:
Mailing Address - City:UPPER BLACK EDDY
Mailing Address - State:PA
Mailing Address - Zip Code:18972
Mailing Address - Country:US
Mailing Address - Phone:610-982-5966
Mailing Address - Fax:610-982-0195
Practice Address - Street 1:2 QUARRY LANE
Practice Address - Street 2:
Practice Address - City:UPPER BLACK EDDY
Practice Address - State:PA
Practice Address - Zip Code:18972
Practice Address - Country:US
Practice Address - Phone:610-982-5966
Practice Address - Fax:610-982-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004423L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075762OtherMEDICARE GROUP