MEDICARE: BACK 2 LIFE OF FLORIDA

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	111N00000X	Chiropractor	CH8146	FL
2	111N00000X	Chiropractor	CH8772	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71494	OTHER	FL	BLUE CROSS BLUE SHIELD
2	1447270566	OTHER	FL	NPI NUMBER E GROTEKE
3	656080	OTHER	FL	UNITED HEALTH CARE
4	70112	OTHER	FL	BLUE CROSS BLUE SHIELD
5	1147626	OTHER	FL	FIRST HEALTH
6	1770650574	OTHER	FL	NPI NUMBER D STAFFORD
7	1038157	OTHER	FL	AMERICAN SPECIALTY HEALTH
8	9067913	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1215146303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK 2 LIFE OF FLORIDA

Provider Business Mailing Address
First Line	:	2905 RIGSBY LN
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4828
Country	:	US
Telephone Number	:	727-797-0500
Fax Number	:	727-797-0050

Provider Business Practice Location Address
First Line	:	1226 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5657
Country	:	US
Telephone Number	:	352-688-8770
Fax Number	:	352-688-8860

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. ERIC K GROTEKE
Credential	:	D.C.
Telephone Number	:	352-688-8770

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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Directions to “BACK 2 LIFE OF FLORIDA ” Practice Location

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