MEDICARE: BACK TO HEALTH NATURAL THERAPIES INC

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	261Q00000X	Clinic/Center	4487	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	539T2BA	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1649454497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO HEALTH NATURAL THERAPIES INC

Provider Business Mailing Address
First Line	:	5300 S ROBERT TRL
Second Line	:	STE 700
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55077-1444
Country	:	US
Telephone Number	:	651-457-2121
Fax Number	:	651-457-5355

Provider Business Practice Location Address
First Line	:	5300 S ROBERT TRL
Second Line	:	STE 700
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55077-1444
Country	:	US
Telephone Number	:	651-457-2121
Fax Number	:	651-457-5355

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT ARLEND ALLAN
Credential	:	D.C.
Telephone Number	:	651-457-2121

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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