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General NPI Number Information
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NPI Number | 1215146303
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Entity Type | Organization
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Legal Business Name | BACK 2 LIFE OF FLORIDA
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1226 MARINER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34609-5657
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Country | US
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Telephone | 352-688-8770
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Fax | 352-688-8860
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Provider Business Mailing Address
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Address Line | 2905 RIGSBY LN
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-4828
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Country | US
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Telephone | 727-797-0500
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Fax | 727-797-0050
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. ERIC K GROTEKE
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Credential | D.C.
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Telephone | 352-688-8770
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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 | CH8146
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8772
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License Number State | FL
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