=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649594953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATARI MEDICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2010
-----------------------------------------------------
Last Update Date | 03/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8215 VAN NUYS BLVD SUITE 300
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-786-9100
-----------------------------------------------------
Fax | 818-786-9102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 PALATINE SUITE 128
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92612-7605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | DR. CHRIS ATAMIAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 818-786-9100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 18313
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------