Provider Demographics
NPI:1013363324
Name:BACK TO HEALTH ACUPUNCTURE AND CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK TO HEALTH ACUPUNCTURE AND CHIROPRACTIC
Other - Org Name:DR. MICHAEL BAGBY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BAGBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-299-3440
Mailing Address - Street 1:1040 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:102
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3170
Mailing Address - Country:US
Mailing Address - Phone:847-870-0280
Mailing Address - Fax:
Practice Address - Street 1:1040 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:102
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3170
Practice Address - Country:US
Practice Address - Phone:847-870-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT92516Medicare UPIN