Healthcare Provider Details

I. General information

NPI: 1831432475
Provider Name (Legal Business Name): BACK TO NATURAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N ORLEANS ST SUITE 303
CHICAGO IL
60654-5098
US

IV. Provider business mailing address

750 N ORLEANS ST SUITE 303
CHICAGO IL
60654-5098
US

V. Phone/Fax

Practice location:
  • Phone: 314-704-4403
  • Fax:
Mailing address:
  • Phone: 314-704-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number038.011981
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number038.011981
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number038.011981
License Number StateIL

VIII. Authorized Official

Name: DR. SARA LYNN MOLNAR
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 314-704-4403