Provider Demographics
NPI:1720883960
Name:ATLETICA CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ATLETICA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:ABLEEN
Authorized Official - Last Name:REALEGENO-ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-431-8567
Mailing Address - Street 1:1407 SAN JACINTO LN
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-2654
Mailing Address - Country:US
Mailing Address - Phone:979-431-8567
Mailing Address - Fax:
Practice Address - Street 1:707 TEXAS AVE S # 202D
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-1967
Practice Address - Country:US
Practice Address - Phone:979-431-8567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty