Provider Demographics
NPI:1861584039
Name:ATLAS ORTHOGONAL CHIROPRACTIC CLINIC LC
Entity type:Organization
Organization Name:ATLAS ORTHOGONAL CHIROPRACTIC CLINIC LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-732-8527
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-0739
Mailing Address - Country:US
Mailing Address - Phone:712-732-8527
Mailing Address - Fax:712-732-8527
Practice Address - Street 1:1515 E LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2677
Practice Address - Country:US
Practice Address - Phone:712-732-8527
Practice Address - Fax:712-732-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190959Medicaid
IA48819OtherBLUE CROSS BLUE SHIELD GR
IA48819Medicare PIN