MEDICARE: ATLAS CHIROPRACTIC SPINE CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	010261	NY

General Provider Information

NPI Number	:	1750805446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS CHIROPRACTIC SPINE CARE, PLLC

Provider Business Mailing Address
First Line	:	65 BROADWAY STE 1003
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-2527
Country	:	US
Telephone Number	:	212-379-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 BROADWAY STE 1003
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-2527
Country	:	US
Telephone Number	:	212-379-6535
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. MICHAEL JOHN D'AVANZO
Credential	:	D.C.
Telephone Number	:	212-379-6535

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	11/15/2018

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