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General NPI Number Information
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NPI Number | 1740899475
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Entity Type | Organization
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Legal Business Name | BACK 2 WORK CLINICS
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 950 E RIVERSIDE DR
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City | EAGLE
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State | ID
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Zip | 83616-6020
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Country | US
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Telephone | 208-965-2262
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Fax | 208-963-3299
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Provider Business Mailing Address
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Address Line | PO BOX 382
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City | MERIDIAN
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State | ID
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Zip | 83680-0382
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Country | US
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Telephone | 208-576-4696
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Fax | 208-963-3299
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Authorized Official
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Title or Position | CEO
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Name | DR. XAVIER A ORTIZ RAMIREZ
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Credential | DC
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Telephone | 208-965-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number |
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License Number State |
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