Provider Demographics
NPI:1881811560
Name:ATC CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ATC CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-588-2242
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588
Mailing Address - Country:US
Mailing Address - Phone:608-588-2242
Mailing Address - Fax:
Practice Address - Street 1:150 EAST JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-588-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization