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General NPI Number Information
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NPI Number | 1255752507
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Entity Type | Organization
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Legal Business Name | ATLAS ADVANTAGE CHIROPRACTIC L.L.C.
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 9766 FALLON AVE NE SUITE 104
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City | MONTICELLO
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State | MN
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Zip | 55362-4588
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Country | US
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Telephone | 320-309-4316
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Fax |
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Provider Business Mailing Address
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Address Line | 9766 FALLON AVE NE SUITE 104
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City | MONTICELLO
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State | MN
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Zip | 55362-4588
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGER AND OWNER
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Name | JENNIFER ELDRIDGE
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Credential | D.C.
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Telephone | 320-309-4316
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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 | 5777
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License Number State | MN
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