MEDICARE: ATLAS SPINE CENTER LLC

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	207Q00000X	Family Medicine Physician	1472	AZ
2	225100000X	Physical Therapist	4477	AZ
3	111N00000X	Chiropractor	7548	AZ

General Provider Information

NPI Number	:	1326216391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS SPINE CENTER LLC

Provider Business Mailing Address
First Line	:	1919 E. MCKELLIPS RD.
Second Line	:	SUITE 106
City	:	MESA
State	:	AZ
Zip	:	85203-2855
Country	:	US
Telephone Number	:	480-833-0302
Fax Number	:	480-833-0904

Provider Business Practice Location Address
First Line	:	1919 E. MCKELLIPS RD.
Second Line	:	SUITE 106
City	:	MESA
State	:	AZ
Zip	:	85203-2855
Country	:	US
Telephone Number	:	480-833-0302
Fax Number	:	480-833-0904

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DAN H FROERER
Credential	:	D.C.
Telephone Number	:	480-833-0302

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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Directions to “ATLAS SPINE CENTER LLC ” Practice Location

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