Healthcare Provider Details

I. General information

NPI: 1649594953
Provider Name (Legal Business Name): ATARI MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 VAN NUYS BLVD SUITE 300
PANORAMA CITY CA
91402-4810
US

IV. Provider business mailing address

25 PALATINE SUITE 128
IRVINE CA
92612-7605
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-9100
  • Fax: 818-786-9102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number18313
License Number StateCA

VIII. Authorized Official

Name: DR. CHRIS ATAMIAN
Title or Position: CLINICAL DIRECTOR
Credential: D.C.
Phone: 818-786-9100