Provider Demographics
NPI:1144576133
Name:BACK 2 ACT CHIROPRACTIC & WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:BACK 2 ACT CHIROPRACTIC & WELLNESS CENTER PLLC
Other - Org Name:BACK 2 ACT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIAMEI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-400-2088
Mailing Address - Street 1:2318 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9706
Mailing Address - Country:US
Mailing Address - Phone:319-855-1588
Mailing Address - Fax:
Practice Address - Street 1:1150 5TH ST STE 288
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2932
Practice Address - Country:US
Practice Address - Phone:319-400-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty