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General NPI Number Information
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NPI Number | 1972778660
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 1808 OAK PARK BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8914
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Country | US
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Telephone | 337-478-5611
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Fax | 337-478-5613
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Provider Business Mailing Address
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Address Line | 1808 OAK PARK BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8914
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Country | US
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Telephone | 337-478-5611
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Fax | 337-478-5613
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Authorized Official
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Title or Position | DIRECTOR
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Name | PETER R BROSNAN
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Credential |
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Telephone | 337-478-5611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 399
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License Number State | LA
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