=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932310893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACK WELLNESS CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 05/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3765 S BROADWAY
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80113-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-781-7825
-----------------------------------------------------
Fax | 303-781-7826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3765 S. BROADWAY ST.
-----------------------------------------------------
City | ENGELWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-781-7825
-----------------------------------------------------
Fax | 303-781-7826
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN H. BAER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 303-781-7825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------