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General NPI Number Information
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NPI Number | 1902747207
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Entity Type | Organization
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Legal Business Name | WAYBACK CHIROPRACTIC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 2432 W NEW ORLEANS ST
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City | BROKEN ARROW
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State | OK
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Zip | 74011-1590
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Country | US
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Telephone | 918-938-1330
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Fax |
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Provider Business Mailing Address
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Address Line | 6105 W BIRMINGHAM CIR
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City | BROKEN ARROW
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State | OK
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Zip | 74011-1478
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAX GONDOLFO
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Credential | DC
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Telephone | 302-650-2831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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