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General NPI Number Information
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NPI Number | 1679156517
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Entity Type | Organization
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Legal Business Name | ATLAS WELLNESS GROUP LLC
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 9250 COLLEGE PKWY STE 4
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City | FORT MYERS
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State | FL
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Zip | 33919-4847
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Country | US
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Telephone | 239-689-8495
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Fax | 239-308-0124
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Provider Business Mailing Address
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Address Line | 9250 COLLEGE PKWY STE 4
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City | FORT MYERS
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State | FL
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Zip | 33919-4847
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Country | US
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Telephone | 239-689-8495
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Fax | 239-308-0124
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. KIMBERLY ANNE SANBORN
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Credential | DC
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Telephone | 239-689-8495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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