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General NPI Number Information
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NPI Number | 1780901769
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Entity Type | Organization
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Legal Business Name | BACK IN HEALTH CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 1031 US HWY 202 N
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3908
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Country | US
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Telephone | 908-218-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 US HIGHWAY 202 N
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3908
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Country | US
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Telephone | 908-218-1800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL GEORGE EOSSO
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Credential | DC
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Telephone | 908-218-1800
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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 | 38MC00673000
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License Number State | NJ
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