Healthcare Provider Details

I. General information

NPI: 1124416193
Provider Name (Legal Business Name): BACK SAFETY & WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18141 DIXIE HWY SUITE 107
HOMEWOOD IL
60430-2238
US

IV. Provider business mailing address

18141 DIXIE HWY SUITE 107
HOMEWOOD IL
60430-2238
US

V. Phone/Fax

Practice location:
  • Phone: 708-365-6353
  • Fax:
Mailing address:
  • Phone: 708-365-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSH ZUMSTEIN
Title or Position: OWNER
Credential: D.C.
Phone: 708-365-6353