MEDICARE: BACK 2 HEALTH 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	2136	OH

General Provider Information

NPI Number	:	1558525261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK 2 HEALTH CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1975 NILES CORTLAND RD NE STE 1
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1093
Country	:	US
Telephone Number	:	330-856-3236
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 NILES CORTLAND RD NE STE 1
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1093
Country	:	US
Telephone Number	:	330-856-3236
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	JOHN P MISTRETTA
Credential	:	DC
Telephone Number	:	330-856-3236

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	07/11/2008

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Directions to “BACK 2 HEALTH CHIROPRACTIC ” Practice Location

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