Healthcare Provider Details

I. General information

NPI: 1376692764
Provider Name (Legal Business Name): BACK TO NORMAL CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CENTRAL ST UNIT 3
IPSWICH MA
01938-1965
US

IV. Provider business mailing address

PO BOX 253
IPSWICH MA
01938-0253
US

V. Phone/Fax

Practice location:
  • Phone: 978-317-6756
  • Fax: 978-412-9099
Mailing address:
  • Phone: 978-317-6756
  • Fax: 978-412-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH1689
License Number StateMA

VIII. Authorized Official

Name: DR. SWIATOSLAW ALEXANDER PADUCHAK
Title or Position: PRESIDENT
Credential: DC
Phone: 978-317-6756