1114066917 NPI number — ATLAS SPECIFIC CHIROPRACTIC

Table of content: (NPI 1114066917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114066917 NPI number — ATLAS SPECIFIC CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLAS SPECIFIC CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114066917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 DENBIGH BLVD STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23608-4485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-283-6929
Provider Business Mailing Address Fax Number:
757-283-6931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 DENBIGH BLVD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23608-4485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-283-6929
Provider Business Practice Location Address Fax Number:
757-283-6931
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOWAL
Authorized Official First Name:
RENATA
Authorized Official Middle Name:
ANNA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-283-6929

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104556353 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00W657A02 . This is a "MEDICARE DR. E. MIERZEJEW" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11501696 . This is a "CAQH DR. E. MIERZEJEWSKI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1477540730 . This is a "NPI DR. E. MIERZEJEWSKI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11281024 . This is a "CAQH DR. RENATA KOWAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1770576738 . This is a "NPI FOR DR. R. KOWAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: U99608 . This is a "UPIN DR. E. MIERZEJEWSKI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 184653 . This is a "BCBS DR. R. KOWAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 00W658A01 . This is a "MEDICARE DR. R. KOWAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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