Provider Demographics
NPI:1750805446
Name:ATLAS CHIROPRACTIC SPINE CARE, PLLC
Entity type:Organization
Organization Name:ATLAS CHIROPRACTIC SPINE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:D'AVANZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-379-6535
Mailing Address - Street 1:65 BROADWAY STE 1003
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2527
Mailing Address - Country:US
Mailing Address - Phone:212-379-6535
Mailing Address - Fax:
Practice Address - Street 1:65 BROADWAY STE 1003
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2527
Practice Address - Country:US
Practice Address - Phone:212-379-6535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty