MEDICARE: BACK WORKS UNLTD INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1407862	OTHER	WA	BLUE CROSS BLUE SHIELD
2	14971	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1437275153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK WORKS UNLTD INC

Provider Business Mailing Address
First Line	:	2149 CASCADE AVE STE 208
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1087
Country	:	US
Telephone Number	:	509-493-2882
Fax Number	:	509-493-2882

Provider Business Practice Location Address
First Line	:	1000 W STEUBEN ST
Second Line	:
City	:	BINGEN
State	:	WA
Zip	:	98605
Country	:	US
Telephone Number	:	509-493-2882
Fax Number	:	509-493-2882

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL E HOLMAN
Credential	:	DC
Telephone Number	:	509-493-2882

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	10/12/2007

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Directions to “BACK WORKS UNLTD INC ” Practice Location

Language	Start Address	Practice Location

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