Healthcare Provider Details

I. General information

NPI: 1326360272
Provider Name (Legal Business Name): BACK TO HEALTH FAMILY CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 LAKE RD STE 3
SAINT ALBANS VT
05478-2268
US

IV. Provider business mailing address

387 LAKE RD STE 3
SAINT ALBANS VT
05478-2268
US

V. Phone/Fax

Practice location:
  • Phone: 802-527-2225
  • Fax: 802-527-2013
Mailing address:
  • Phone: 802-527-2225
  • Fax: 802-527-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberVT982
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License NumberVT 982
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberVT982
License Number StateVT

VIII. Authorized Official

Name: DR. MAUREEN ANN KEEFE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 802-527-2225