MEDICARE: BACK NORTH CHIROPRACTIC CARE PLC

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	006-0001138	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4352646	OTHER	VT	CIGNA
2	98L1880	OTHER	VT	LANDMARK
3	BACK68321	OTHER	VT	BCBSVT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225034754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK NORTH CHIROPRACTIC CARE PLC

Provider Business Mailing Address
First Line	:	1127 NORTH AVE
Second Line	:	STE 21
City	:	BURLINGTON
State	:	VT
Zip	:	05401-2756
Country	:	US
Telephone Number	:	802-652-0015
Fax Number	:	802-652-0016

Provider Business Practice Location Address
First Line	:	1127 NORTH AVE
Second Line	:	STE 21
City	:	BURLINGTON
State	:	VT
Zip	:	05401-2756
Country	:	US
Telephone Number	:	802-652-0015
Fax Number	:	802-652-0016

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	DR. DANIEL S WEBER
Credential	:	D.C.
Telephone Number	:	802-652-0015

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/22/2020

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