Healthcare Provider Details

I. General information

NPI: 1518174556
Provider Name (Legal Business Name): BACK TO HEALTH CHIROPRACTIC CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MAIN ST
ELKO MN
55020-9701
US

IV. Provider business mailing address

10880 175TH CT W SUITE #120
LAKEVILLE MN
55044-8781
US

V. Phone/Fax

Practice location:
  • Phone: 952-461-5110
  • Fax: 952-898-7626
Mailing address:
  • Phone: 952-892-0898
  • Fax: 952-898-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4200
License Number StateMN

VIII. Authorized Official

Name: DR. BRIAN THOMAS SONTAG
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 952-892-0898