Provider Demographics
NPI:1073793436
Name:BACK TO HEALTH CHIROPRACTIC OF RANGELY, INC.
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC OF RANGELY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-675-2273
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-0666
Mailing Address - Country:US
Mailing Address - Phone:970-675-2273
Mailing Address - Fax:970-675-2273
Practice Address - Street 1:402 W MAIN ST STE 135
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-2408
Practice Address - Country:US
Practice Address - Phone:970-675-2273
Practice Address - Fax:970-675-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29575842Medicaid
U76953Medicare UPIN
COC460328Medicare PIN