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General NPI Number Information
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NPI Number | 1548327018
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Entity Type | Organization
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Legal Business Name | ATLAS CHIROPRACTIC CLINIC SC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 S WATER ST SUITE 7
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City | SPARTA
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State | WI
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Zip | 54656
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Country | US
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Telephone | 608-269-2626
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Fax | 608-269-0157
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Provider Business Mailing Address
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Address Line | PO BOX 251
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City | SPARTA
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State | WI
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Zip | 54656-0251
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Country | US
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Telephone | 608-269-2626
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Fax | 608-269-0157
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL M BEKKUM
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Credential | DC
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Telephone | 608-269-2626
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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 | 2906
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License Number State | WI
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