Provider Demographics
NPI:1013042647
Name:BACK TO HEALTH CHIROPRACTIC OF RISING SUN, PC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC OF RISING SUN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-525-6546
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:VEVAY
Mailing Address - State:IN
Mailing Address - Zip Code:47043-0066
Mailing Address - Country:US
Mailing Address - Phone:812-525-6546
Mailing Address - Fax:812-438-9222
Practice Address - Street 1:100 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:IN
Practice Address - Zip Code:47040-1172
Practice Address - Country:US
Practice Address - Phone:812-438-9222
Practice Address - Fax:812-438-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001849A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00045015OtherMEDICARE RAILROAD
IN000000298895OtherBLUE CROSS BLUE SHEILD
INP00045015OtherMEDICARE RAILROAD
U75788Medicare UPIN