MEDICARE: DR. BRIAN ATKISSON D.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	111NS0005X	Sports Physician Chiropractor	38MC00284400	NJ

General Provider Information

NPI Number	:	1598842080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN ATKISSON D.C.

Provider Business Mailing Address
First Line	:	3110 OCEAN HEIGHTS AVE STE 2
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-7708
Country	:	US
Telephone Number	:	609-653-6400
Fax Number	:	609-653-8347

Provider Business Practice Location Address
First Line	:	3110 OCEAN HEIGHTS AVE STE 2
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-7708
Country	:	US
Telephone Number	:	609-653-6400
Fax Number	:	609-653-8347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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