MEDICARE: BACK TO BALANCE CHIRORACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1265301543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO BALANCE CHIRORACTIC LLC

Provider Business Mailing Address
First Line	:	R955 CALLE 18 URB AULTURAS DE RIO GRANDE
Second Line	:
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR 3 ESQUINA CARR 186 KM 26.9 SEGUNDA PLANTA
Second Line	:	BO. JIMENEZ
City	:	RIO GRANDE
State	:	PR
Zip	:	00745
Country	:	US
Telephone Number	:	787-550-5349
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIZA LOPEZ
Credential	:	DC
Telephone Number	:	787-550-5349

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	01/15/2026

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