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General NPI Number Information
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NPI Number | 1215517263
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Entity Type | Organization
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Legal Business Name | BACK ON TRACK CHIROPRACTIC WELLNESS PLLC
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 501 SW WILSHIRE BLVD STE B
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City | BURLESON
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State | TX
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Zip | 76028-5334
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Country | US
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Telephone | 817-295-7444
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Fax | 682-841-1443
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Provider Business Mailing Address
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Address Line | 501 SW WILSHIRE BLVD STE B
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City | BURLESON
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State | TX
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Zip | 76028-5334
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Country | US
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Telephone | 817-295-7444
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Fax | 682-841-1443
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | KEITH RABER
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Credential | DC
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Telephone | 817-295-7444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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