Healthcare Provider Details

I. General information

NPI: 1861567596
Provider Name (Legal Business Name): BACK TO HEALTH CHIROPRACTIC OF WAKEFIELD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 POINT JUDITH RD #31C
NARRAGANSETT RI
02882
US

IV. Provider business mailing address

140 POINT JUDITH RD #31C
NARRAGANSETT RI
02882
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-2000
  • Fax: 401-782-2916
Mailing address:
  • Phone: 401-789-2000
  • Fax: 401-782-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAY S KORSEN
Title or Position: PRESIDENT
Credential: DC
Phone: 401-739-2000