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General NPI Number Information
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NPI Number | 1104278068
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Entity Type | Organization
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Legal Business Name | BACK TOGETHER CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/04/2016
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Last Update Date | 07/04/2016
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Provider Practice Location Address
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Address Line | 4122 KEATON CROSSING BLVD SUITE 105
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City | O FALLON
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State | MO
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Zip | 63368-8218
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Country | US
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Telephone | 636-224-8130
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Fax |
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Provider Business Mailing Address
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Address Line | 124 HARMONY VILLA WAY
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City | COTTLEVILLE
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State | MO
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Zip | 63376-2890
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Country | US
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Telephone | 337-315-4264
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. LAKENDRIA HAWKINS
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Credential |
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Telephone | 337-315-4264
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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 | 2015004019
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License Number State | MO
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