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General NPI Number Information
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NPI Number | 1083590426
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH OF VISTANCIA
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 28421 N VISTANCIA BLVD STE A101
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City | PEORIA
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State | AZ
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Zip | 85383-2198
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Country | US
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Telephone | 602-676-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 3051 W SOUSA CT
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City | ANTHEM
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State | AZ
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Zip | 85086-1700
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Country | US
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Telephone | 602-676-6306
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | LUKE SHILLIG
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Credential | DO
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Telephone | 623-551-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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