MEDICARE: BACKCARE PLUS CHIROPRACTIC

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
1	261QH0100X	Health Service Clinic/Center	2134	GA

General Provider Information

NPI Number	:	1154336899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACKCARE PLUS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3973 ATLANTA HWY
Second Line	:	STE. 400
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-3752
Country	:	US
Telephone Number	:	770-466-9990
Fax Number	:	770-466-9391

Provider Business Practice Location Address
First Line	:	3973 ATLANTA HWY
Second Line	:	STE. 400
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-3752
Country	:	US
Telephone Number	:	770-466-9990
Fax Number	:	770-466-9391

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN EVERETT MULLINS
Credential	:	D. C.
Telephone Number	:	770-466-9990

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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