Healthcare Provider Details

I. General information

NPI: 1922875988
Provider Name (Legal Business Name): BACK 2 LIFE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1510
US

IV. Provider business mailing address

4008 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1510
US

V. Phone/Fax

Practice location:
  • Phone: 304-400-4056
  • Fax:
Mailing address:
  • Phone: 304-400-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA TYLER MORGAN
Title or Position: CLINIC DIRECTOR/OWNER
Credential: DC
Phone: 304-549-3199