Healthcare Provider Details

I. General information

NPI: 1306700737
Provider Name (Legal Business Name): BACK TO LIFE CHIROPRACTIC CENTER II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3164 HIGHWAY 431 STE 7
ROANOKE AL
36274-1702
US

IV. Provider business mailing address

1505 LAFAYETTE PKWY
LAGRANGE GA
30241-2513
US

V. Phone/Fax

Practice location:
  • Phone: 678-522-9221
  • Fax:
Mailing address:
  • Phone: 706-882-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: TAMMI LYN KAMINSKY
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 706-882-5737