Healthcare Provider Details

I. General information

NPI: 1871389650
Provider Name (Legal Business Name): BACK 2 BACK CHIROPRACTIC CANTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 SIXES RD STE 110
CANTON GA
30114-9120
US

IV. Provider business mailing address

3422 SIXES RD STE 110
CANTON GA
30114-9120
US

V. Phone/Fax

Practice location:
  • Phone: 715-862-2423
  • Fax:
Mailing address:
  • Phone: 715-862-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN WALLIN
Title or Position: OWNER
Credential: DC
Phone: 715-862-2423