Provider Demographics
NPI:1114197597
Name:BACK2HEALTH CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:BACK2HEALTH CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHMARUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-819-9748
Mailing Address - Street 1:180 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4705
Mailing Address - Country:US
Mailing Address - Phone:201-820-3343
Mailing Address - Fax:201-820-3344
Practice Address - Street 1:180 GRAND AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4705
Practice Address - Country:US
Practice Address - Phone:201-820-3343
Practice Address - Fax:201-820-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00663600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty