Healthcare Provider Details

I. General information

NPI: 1679156517
Provider Name (Legal Business Name): ATLAS WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 COLLEGE PKWY STE 4
FORT MYERS FL
33919-4847
US

IV. Provider business mailing address

9250 COLLEGE PKWY STE 4
FORT MYERS FL
33919-4847
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-8495
  • Fax: 239-308-0124
Mailing address:
  • Phone: 239-689-8495
  • Fax: 239-308-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY ANNE SANBORN
Title or Position: CO-OWNER
Credential: DC
Phone: 239-689-8495