Provider Demographics
NPI:1679156517
Name:ATLAS WELLNESS GROUP LLC
Entity type:Organization
Organization Name:ATLAS WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-689-8495
Mailing Address - Street 1:9250 COLLEGE PKWY STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4847
Mailing Address - Country:US
Mailing Address - Phone:239-689-8495
Mailing Address - Fax:239-308-0124
Practice Address - Street 1:9250 COLLEGE PKWY STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4847
Practice Address - Country:US
Practice Address - Phone:239-689-8495
Practice Address - Fax:239-308-0124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULFSIDE CHIROPRACTIC HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1295268910OtherPARENT ORGANIZATION NPI
FL1336672344OtherINDIVIDUAL NPI - KIMBERLY SANBORN, DC