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General NPI Number Information
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NPI Number | 1265521447
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CHIROPRACTIC CLINIC, PA
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5231 E. FRONTAGE HWY 52 RD NW SUITE 201 &202
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City | ROCHESTER
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State | MN
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Zip | 55901-4156
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Country | US
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Telephone | 507-280-6186
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Fax | 507-280-7682
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Provider Business Mailing Address
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Address Line | 5231 E. FRONTAGE HWY 52 RD NW SUITE 201 &202
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City | ROCHESTER
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State | MN
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Zip | 55901-4156
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Country | US
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Telephone | 507-280-6186
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Fax | 507-280-7682
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. ROGER A MARQUARDT
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Credential | D.C.
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Telephone | 507-280-6186
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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 | 2554
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 208
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License Number State | MN
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