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General NPI Number Information
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NPI Number | 1669498036
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Entity Type | Organization
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Legal Business Name | BACK TO MEDICINE, INC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1215 PLUMAS ST STE 101
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City | YUBA CITY
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State | CA
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Zip | 95991-3455
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Country | US
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Telephone | 530-751-1701
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Fax | 530-751-1705
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Provider Business Mailing Address
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Address Line | 1215 PLUMAS ST STE 101
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City | YUBA CITY
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State | CA
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Zip | 95991-3455
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Country | US
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Telephone | 530-751-1701
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Fax | 530-751-1705
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. DWAIN W RICKERTSEN
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Credential | M.D.
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Telephone | 530-751-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A450730
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License Number State | CA
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