Healthcare Provider Details

I. General information

NPI: 1083644793
Provider Name (Legal Business Name): BACK 2 LIFE HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E. 2ND STREET
CASA GRANDE AZ
85222
US

IV. Provider business mailing address

2821 H STREET
BAKERSFIELD CA
93301
US

V. Phone/Fax

Practice location:
  • Phone: 520-421-9552
  • Fax: 520-421-9553
Mailing address:
  • Phone: 661-322-7500
  • Fax: 661-322-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7417
License Number StateAZ

VIII. Authorized Official

Name: MRS. SHAWN RENEE DODD
Title or Position: PRESIDENT
Credential:
Phone: 661-322-7500