MEDICARE: BACK TO LIFE 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1386731040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO LIFE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1309 BUCKTAIL RD
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3264
Country	:	US
Telephone Number	:	814-834-1134
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 BUCKTAIL RD
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3264
Country	:	US
Telephone Number	:	814-834-1134
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL J CARR
Credential	:	D.C.
Telephone Number	:	814-834-1134

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2020

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