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General NPI Number Information
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NPI Number | 1598016917
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Entity Type | Organization
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Legal Business Name | BACK TO LIFE CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 1912 DORCHESTER AVE
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City | DORCHESTER
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State | MA
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Zip | 02124-3765
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Country | US
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Telephone | 617-506-8834
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Fax | 617-506-8934
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Provider Business Mailing Address
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Address Line | 1912 DORCHESTER AVE
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City | DORCHESTER
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State | MA
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Zip | 02124-3765
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Country | US
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Telephone | 617-506-8834
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Fax | 617-506-8934
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. ANIL R NAIR
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Credential | DC
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Telephone | 617-506-8834
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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 | CH 2560
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License Number State | MA
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