Healthcare Provider Details

I. General information

NPI: 1063406379
Provider Name (Legal Business Name): BACK TO HEALTH PLUS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3757 MEADOWBROOKE CIR
DE FOREST WI
53532-2872
US

IV. Provider business mailing address

3757 MEADOWBROOKE CIR
DE FOREST WI
53532-2872
US

V. Phone/Fax

Practice location:
  • Phone: 608-630-3564
  • Fax:
Mailing address:
  • Phone: 608-630-3564
  • Fax: 608-630-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAWN R CADWALLADER
Title or Position: OWNER
Credential: DC
Phone: 608-630-3564