Provider Demographics
NPI:1326405119
Name:ATLAS CHIROPRACTIC OF GILLETTE, LLC
Entity type:Organization
Organization Name:ATLAS CHIROPRACTIC OF GILLETTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-686-3734
Mailing Address - Street 1:405 W BOXELDER RD
Mailing Address - Street 2:SUITE D2
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5320
Mailing Address - Country:US
Mailing Address - Phone:307-686-3734
Mailing Address - Fax:307-682-7531
Practice Address - Street 1:405 W BOXELDER RD
Practice Address - Street 2:SUITE D2
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5320
Practice Address - Country:US
Practice Address - Phone:307-686-3734
Practice Address - Fax:307-682-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty