Provider Demographics
NPI:1124393004
Name:BACK TO HEALTH CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-986-9091
Mailing Address - Street 1:3000 SE GRIMES BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-5040
Mailing Address - Country:US
Mailing Address - Phone:515-986-9091
Mailing Address - Fax:
Practice Address - Street 1:3000 SE GRIMES BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-5040
Practice Address - Country:US
Practice Address - Phone:515-986-9091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty