=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831358910
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATKINS CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 10/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2621 70TH AVE W STE A
-----------------------------------------------------
City | UNIVERSITY PLACE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98466-5459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-752-7522
-----------------------------------------------------
Fax | 253-759-3552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2621 70TH AVE W STE A
-----------------------------------------------------
City | UNIVERSITY PLACE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98466-5459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-752-7522
-----------------------------------------------------
Fax | 253-759-3552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | DR. PETER ROBERT ATKINS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 253-752-7522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00001010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------