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General NPI Number Information
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NPI Number | 1689889461
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Entity Type | Organization
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Legal Business Name | BACK TO WELLNESS CHIROPRACTIC INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 409 W BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-7401
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Country | US
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Telephone | 813-685-7577
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Fax | 813-684-9145
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Provider Business Mailing Address
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Address Line | 409 W BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-7401
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Country | US
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Telephone | 813-685-7577
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Fax | 813-684-9145
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELE MILLER VALDES
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Credential | DC
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Telephone | 813-685-7577
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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 | CH7554
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License Number State | FL
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