Healthcare Provider Details

I. General information

NPI: 1780750034
Provider Name (Legal Business Name): BACK TO HEALTH CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10607 FRANCE AVE S
BLOOMINGTON MN
55431-3539
US

IV. Provider business mailing address

10607 FRANCE AVE S
BLOOMINGTON MN
55431-3539
US

V. Phone/Fax

Practice location:
  • Phone: 952-881-5703
  • Fax: 952-881-6871
Mailing address:
  • Phone: 952-881-5703
  • Fax: 952-881-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2928
License Number StateMN

VIII. Authorized Official

Name: DR. MATTHEW JAMES ANDERSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 952-881-5703