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General NPI Number Information
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NPI Number | 1154480663
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CLINIC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6800 DALLAS ST STE. A
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City | FORT SMITH
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State | AR
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Zip | 72903-5034
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Country | US
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Telephone | 479-484-7575
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Fax | 479-484-7581
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Provider Business Mailing Address
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Address Line | 6800 DALLAS ST STE. A
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City | FORT SMITH
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State | AR
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Zip | 72903-5034
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Country | US
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Telephone | 479-484-7575
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Fax | 479-484-7581
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. JULIE L GRAHAM
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Credential | D.C.
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Telephone | 479-484-7575
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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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