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General NPI Number Information
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NPI Number | 1386976165
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CHIROPRACTIC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 629 E EISENHOWER BLVD
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City | LOVELAND
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State | CO
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Zip | 80538
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Country | US
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Telephone | 970-635-2848
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Fax | 970-461-0004
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Provider Business Mailing Address
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Address Line | 629 E EISENHOWER BLVD
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City | LOVELAND
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State | CO
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Zip | 80538
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Country | US
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Telephone | 970-635-2848
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Fax | 970-461-0004
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. DEREK CARROLL
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Credential | DC
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Telephone | 970-635-2848
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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 | 6120
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License Number State | CO
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