Healthcare Provider Details

I. General information

NPI: 1770897704
Provider Name (Legal Business Name): BACK & BODY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 STRYKER ST NUMBER B
ARCHBOLD OH
43502-1144
US

IV. Provider business mailing address

301 STRYKER ST NUMBER B
ARCHBOLD OH
43502-1144
US

V. Phone/Fax

Practice location:
  • Phone: 567-444-4574
  • Fax:
Mailing address:
  • Phone: 567-444-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. LANA JOHNSON
Title or Position: CO-OWNER
Credential: D.C.
Phone: 567-444-4574