Healthcare Provider Details

I. General information

NPI: 1093085763
Provider Name (Legal Business Name): BACK TO HEALTH CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 TIFFIN AVE.
FINDLAY OH
45840
US

IV. Provider business mailing address

1611 TIFFIN AVE.
FINDLAY OH
45840
US

V. Phone/Fax

Practice location:
  • Phone: 419-420-1555
  • Fax: 419-420-1556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2287
License Number StateOH

VIII. Authorized Official

Name: DR. CHRISTOPHER BERRY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 419-420-1555