MEDICARE: ATLAS SPECIFIC CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104556353	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00W657A02	OTHER	VA	MEDICARE DR. E. MIERZEJEW
8	00W658A01	OTHER	VA	MEDICARE DR. R. KOWAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	11501696	OTHER	VA	CAQH DR. E. MIERZEJEWSKI
3	1477540730	OTHER	VA	NPI DR. E. MIERZEJEWSKI
4	11281024	OTHER	VA	CAQH DR. RENATA KOWAL
5	1770576738	OTHER	VA	NPI FOR DR. R. KOWAL
6	U99608	OTHER	VA	UPIN DR. E. MIERZEJEWSKI
7	184653	OTHER	VA	BCBS DR. R. KOWAL

General Provider Information

NPI Number	:	1114066917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS SPECIFIC CHIROPRACTIC

Provider Business Mailing Address
First Line	:	640 DENBIGH BLVD STE 4
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-4485
Country	:	US
Telephone Number	:	757-283-6929
Fax Number	:	757-283-6931

Provider Business Practice Location Address
First Line	:	640 DENBIGH BLVD STE 4
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-4485
Country	:	US
Telephone Number	:	757-283-6929
Fax Number	:	757-283-6931

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RENATA ANNA KOWAL
Credential	:	D.C.
Telephone Number	:	757-283-6929

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2020

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Directions to “ATLAS SPECIFIC CHIROPRACTIC ” Practice Location

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