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General NPI Number Information
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NPI Number | 1366549586
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1015 S 11TH ST
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City | DECATUR
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State | IN
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Zip | 46733-2164
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Country | US
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Telephone | 260-728-4194
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Fax | 260-728-4195
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Provider Business Mailing Address
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Address Line | 10963 VAN WERT DECATUR RD
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City | VAN WERT
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State | OH
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Zip | 45891-9211
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Country | US
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Telephone | 419-238-6686
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Fax | 419-238-6201
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Authorized Official
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Title or Position | OWNER
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Name | SHAD ALAN FOSTER
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Credential | D.C
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Telephone | 419-238-6686
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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 | 8002146A
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License Number State | IN
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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 | 08002260A
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License Number State | IN
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