Provider Demographics
NPI:1033384094
Name:BACK TO LIFE CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:BACK TO LIFE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-882-5737
Mailing Address - Street 1:1468 LAFAYETTE PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-2605
Mailing Address - Country:US
Mailing Address - Phone:706-882-5737
Mailing Address - Fax:706-882-5789
Practice Address - Street 1:1468 LAFAYETTE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2605
Practice Address - Country:US
Practice Address - Phone:706-882-5737
Practice Address - Fax:706-882-5789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK TO LIFE CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty