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General NPI Number Information
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NPI Number | 1154763829
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Entity Type | Organization
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Legal Business Name | ATLAS CHIROPRACTIC & WELLNESS, PC
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 115 SOUTHPORT RD STE B
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City | SPARTANBURG
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State | SC
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Zip | 29306-3814
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Country | US
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Telephone | 864-804-6612
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Fax | 864-488-2216
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Provider Business Mailing Address
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Address Line | PO BOX 2068
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City | GAFFNEY
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State | SC
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Zip | 29342-2068
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Country | US
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Telephone | 864-488-0410
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Fax | 864-488-2216
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAD RICHARD WAGNER
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Credential | DC
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Telephone | 864-488-0410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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