MEDICARE: ATLAS CHIROPRACTIC OF WYOMISSING, P.C.

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	DC007924L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AT1441200	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1396766085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS CHIROPRACTIC OF WYOMISSING, P.C.

Provider Business Mailing Address
First Line	:	2917 WINDMILL RD
Second Line	:	SUITE 4
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1679
Country	:	US
Telephone Number	:	610-685-8527
Fax Number	:

Provider Business Practice Location Address
First Line	:	2917 WINDMILL RD
Second Line	:	SUITE 4
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1679
Country	:	US
Telephone Number	:	610-685-8527
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARC ANTHONY CALICCHIO
Credential	:	D.C.
Telephone Number	:	610-685-8527

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	02/10/2015

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