Healthcare Provider Details

I. General information

NPI: 1457376212
Provider Name (Legal Business Name): BIG SPRING BACK REHAB & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 LANCASTER
BIG SPRING TX
79720
US

IV. Provider business mailing address

1703 LANCASTER
BIG SPRING TX
79720
US

V. Phone/Fax

Practice location:
  • Phone: 432-263-2915
  • Fax: 432-267-3581
Mailing address:
  • Phone: 432-263-2915
  • Fax: 432-267-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: JAMES WRAY WARREN
Title or Position: OWNER
Credential: DC
Phone: 432-267-2915