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General NPI Number Information
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NPI Number | 1356749741
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CHIROPRACTIC AND WELLNESS
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 4425 OLD RIDGE RD
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City | WILLIAMSON
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State | NY
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Zip | 14589-9363
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Country | US
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Telephone | 585-626-6858
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 OLD RIDGE RD
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City | WILLIAMSON
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State | NY
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Zip | 14589-9363
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Country | US
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Telephone | 585-626-6858
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. DANA MARIE DELANCEY
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Credential | D.C., MSACN
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Telephone | 585-626-6858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 70012413
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License Number State | NY
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