Provider Demographics
NPI:1023196243
Name:BACK HEALTH PLUS, LLC
Entity Type:Organization
Organization Name:BACK HEALTH PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-692-0515
Mailing Address - Street 1:PO BOX 4032
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-4032
Mailing Address - Country:US
Mailing Address - Phone:360-692-0515
Mailing Address - Fax:360-692-0515
Practice Address - Street 1:9030 PACIFIC AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8555
Practice Address - Country:US
Practice Address - Phone:360-692-0515
Practice Address - Fax:360-692-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB13242Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER