MEDICARE: BACK PAIN CHIROPRACTIC

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		CA

General Provider Information

NPI Number	:	1477763902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK PAIN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1111 N BRISTOL ST STE J
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-2140
Country	:	US
Telephone Number	:	714-434-6875
Fax Number	:	714-434-1096

Provider Business Practice Location Address
First Line	:	2800 W WARNER AVE STE C
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5466
Country	:	US
Telephone Number	:	714-434-6875
Fax Number	:	714-434-1096

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. THERESA E MCKEE
Credential	:
Telephone Number	:	714-434-6875

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/21/2022

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Directions to “BACK PAIN CHIROPRACTIC ” Practice Location

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