=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730258864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLAS FAMILY CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 10/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 698 BOYSON RD SUITE B
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52233-1216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-393-7744
-----------------------------------------------------
Fax | 319-393-1035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 698 BOYSON RD SUITE B
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52233-1216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-393-7744
-----------------------------------------------------
Fax | 319-393-1035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MAGGIE ANN SELLERS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 319-393-7744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 06454
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------