Provider Demographics
NPI:1073785036
Name:BACK TO HEALTH CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:B
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-348-3400
Mailing Address - Street 1:11811 MUKILTEO SPEEDWAY STE 105
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5442
Mailing Address - Country:US
Mailing Address - Phone:425-348-3400
Mailing Address - Fax:425-710-4030
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY STE 105
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-348-3400
Practice Address - Fax:425-710-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003004261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU25399Medicare UPIN
WAAB02935Medicare PIN