MEDICARE: BACKWORX CHIROPRACTIC AND DECOMPRESSION, PLLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1598474512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACKWORX CHIROPRACTIC AND DECOMPRESSION, PLLC

Provider Business Mailing Address
First Line	:	5310 N TARRANT PKWY STE 132
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7300
Country	:	US
Telephone Number	:	817-849-2165
Fax Number	:	817-849-2208

Provider Business Practice Location Address
First Line	:	5310 N TARRANT PKWY STE 132
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7300
Country	:	US
Telephone Number	:	817-849-2165
Fax Number	:	817-849-2208

Authorized Official
Title or Position	:	PROVIDER
Name	:	DR. JEFFREY ALAN ZWIERSTRA
Credential	:	DC
Telephone Number	:	817-343-1143

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	11/17/2022

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