Healthcare Provider Details

I. General information

NPI: 1134903719
Provider Name (Legal Business Name): ATLAS HOLISTIC HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 WILLIAM D TATE AVE
GRAPEVINE TX
76051-4030
US

IV. Provider business mailing address

PO BOX 1326
GRAPEVINE TX
76099-1326
US

V. Phone/Fax

Practice location:
  • Phone: 817-416-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEAN ALLEN
Title or Position: OWNER
Credential: DC
Phone: 817-416-9800