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General NPI Number Information
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NPI Number | 1831534130
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Entity Type | Organization
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Legal Business Name | BACK TO BALANCE CHIROPRACTIC AND WELLNESS PLLC
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 2739 S 5600 W STE 170
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City | WEST VALLEY
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State | UT
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Zip | 84120-4633
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Country | US
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Telephone | 801-966-5106
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Fax | 855-421-3750
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Provider Business Mailing Address
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Address Line | 2739 S 5600 W STE 170
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City | WEST VALLEY
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State | UT
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Zip | 84120-4633
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Country | US
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Telephone | 801-966-5106
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Fax | 855-421-3750
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHANIEL DREW ROBERTS
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Credential | DC
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Telephone | 801-706-5816
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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 | 8622553-1202
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License Number State | UT
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