Healthcare Provider Details

I. General information

NPI: 1932310893
Provider Name (Legal Business Name): BACK WELLNESS CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3765 S BROADWAY
ENGLEWOOD CO
80113-3611
US

IV. Provider business mailing address

3765 S. BROADWAY ST.
ENGELWOOD CO
80113
US

V. Phone/Fax

Practice location:
  • Phone: 303-781-7825
  • Fax: 303-781-7826
Mailing address:
  • Phone: 303-781-7825
  • Fax: 303-781-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN H. BAER
Title or Position: OWNER
Credential: DC
Phone: 303-781-7825