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NPI Code Detail

MEDICARE: BACK TO HEALTH ACUPUNCTURE AND CHIROPRACTIC CENTER, P.A.

MEDICARE: BACK TO HEALTH ACUPUNCTURE AND CHIROPRACTIC CENTER, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor4107MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1831S1BAOTHERMNBCBS GROUP NUMBER

General Provider Information

NPI Number : 1043372204
Entity Type Code : Organization
Provider Name (Legal Business Name) : BACK TO HEALTH ACUPUNCTURE AND CHIROPRACTIC CENTER, P.A.
Provider Business Mailing Address
First Line : 12 2ND AVE S
Second Line :
City : SAUK RAPIDS
State : MN
Zip : 56379-1408
Country : US
Telephone Number : 320-257-6008
Fax Number : 320-257-6009
Provider Business Practice Location Address
First Line : 12 2ND AVE S
Second Line :
City : SAUK RAPIDS
State : MN
Zip : 56379-1408
Country : US
Telephone Number : 320-257-6008
Fax Number : 320-257-6009
Authorized Official
Title or Position : PRESIDENT
Name : JEREMIAH BURSCH
Credential : D.C.
Telephone Number : 320-257-6008
Provider Enumeration Date : 12/14/2006
Last Update Date : 09/20/2012

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