MEDICARE: BACK & BEYOND LLC

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		AZ

General Provider Information

NPI Number	:	1487134508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK & BEYOND LLC

Provider Business Mailing Address
First Line	:	1419 E BOSTON ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-6168
Country	:	US
Telephone Number	:	708-691-5823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 W CHANDLER BLVD STE 4
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6284
Country	:	US
Telephone Number	:	708-691-5823
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. DEAN BURCHENSON
Credential	:	DC
Telephone Number	:	480-750-8900

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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Directions to “BACK & BEYOND LLC ” Practice Location

Language	Start Address	Practice Location

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