Provider Demographics
NPI:1750595658
Name:ATWELL FAMILY CHIROPRACTIC AND WELLNESS P.L.C.
Entity type:Organization
Organization Name:ATWELL FAMILY CHIROPRACTIC AND WELLNESS P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:H
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-442-8294
Mailing Address - Street 1:1811 VIRGINIA AVE.
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802
Mailing Address - Country:US
Mailing Address - Phone:540-442-8294
Mailing Address - Fax:
Practice Address - Street 1:1811 VIRGINIA AVE.
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802
Practice Address - Country:US
Practice Address - Phone:540-442-8294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU86444Medicare UPIN
VA350001192Medicare ID - Type Unspecified