MEDICARE: ATLANTIC HEALTHCARE ASSOCIATES

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

General Provider Information

NPI Number	:	1962031310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC HEALTHCARE ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 32303
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21282-2303
Country	:	US
Telephone Number	:	410-580-9191
Fax Number	:	410-500-5211

Provider Business Practice Location Address
First Line	:	7034 LIBERTY RD
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-5801
Country	:	US
Telephone Number	:	410-580-9191
Fax Number	:	410-500-5211

Authorized Official
Title or Position	:	MANAGING AGENT
Name	:	OKSANA MINAKER
Credential	:
Telephone Number	:	410-580-9191

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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