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General NPI Number Information
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NPI Number | 1467626580
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Entity Type | Organization
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Legal Business Name | ATLAS FAMILY CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 2310 MILDRED ST W STE 130
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-6055
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Country | US
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Telephone | 253-460-4244
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Fax | 877-841-5137
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Provider Business Mailing Address
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Address Line | 2310 MILDRED ST W STE 130
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-6055
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Country | US
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Telephone | 253-460-4244
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Fax | 877-841-5137
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARRYL WILLIAM ROUNDY
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Credential | D.C.
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Telephone | 253-460-4244
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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 | CH00003078
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License Number State | WA
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