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General NPI Number Information
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NPI Number | 1356531404
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 755 NORTH AVE STE B
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-3152
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Country | US
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Telephone | 970-257-9199
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Fax | 970-257-1880
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Provider Business Mailing Address
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Address Line | 755 NORTH AVE STE B
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-3152
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Country | US
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Telephone | 970-257-9199
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Fax | 970-257-1880
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | DR. DANIEL LONQUIST
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Credential | D.C.
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Telephone | 970-257-9199
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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 | 4322
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License Number State | CO
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