=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396414223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATRIUM HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2021
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2821 N BALLAS RD STE 105
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-872-9955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2821 N BALLAS RD STE 105
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-872-9955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | BRYSON COLT WILBANKS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 314-872-9955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------