MEDICARE: BACK TO WELLNESS MEDICAL CENTER

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	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780229112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO WELLNESS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2669 NE TWIN KNOLLS DR STE 208
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6206
Country	:	US
Telephone Number	:	541-633-6563
Fax Number	:	541-550-2218

Provider Business Practice Location Address
First Line	:	2669 NE TWIN KNOLLS DR STE 208
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6206
Country	:	US
Telephone Number	:	541-633-6563
Fax Number	:	541-550-2218

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. HELMUT ERWIN EICHNER
Credential	:	CHIROPRACTOR
Telephone Number	:	541-633-6563

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	11/08/2019

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Directions to “BACK TO WELLNESS MEDICAL CENTER ” Practice Location

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