Provider Demographics
NPI:1043372204
Name:BACK TO HEALTH ACUPUNCTURE AND CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:BACK TO HEALTH ACUPUNCTURE AND CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-257-6008
Mailing Address - Street 1:12 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1408
Mailing Address - Country:US
Mailing Address - Phone:320-257-6008
Mailing Address - Fax:320-257-6009
Practice Address - Street 1:12 2ND AVE S
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1408
Practice Address - Country:US
Practice Address - Phone:320-257-6008
Practice Address - Fax:320-257-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN831S1BAOtherBCBS GROUP NUMBER
MNDB6516Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
MNC03545Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER