Healthcare Provider Details

I. General information

NPI: 1538381314
Provider Name (Legal Business Name): BACK TO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 1ST ST
LOS ALTOS CA
94022-3605
US

IV. Provider business mailing address

371 1ST ST
LOS ALTOS CA
94022-3605
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-7973
  • Fax:
Mailing address:
  • Phone: 650-941-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number185960
License Number StateCA

VIII. Authorized Official

Name: DR. JAMIE P LUCIA
Title or Position: CLINCI DIRECTOR
Credential: DC
Phone: 650-941-7973