Provider Demographics
NPI:1154480663
Name:BACK TO HEALTH CLINIC
Entity Type:Organization
Organization Name:BACK TO HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-484-7575
Mailing Address - Street 1:6800 DALLAS ST
Mailing Address - Street 2:STE. A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5034
Mailing Address - Country:US
Mailing Address - Phone:479-484-7575
Mailing Address - Fax:479-484-7581
Practice Address - Street 1:6800 DALLAS ST
Practice Address - Street 2:STE. A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5034
Practice Address - Country:US
Practice Address - Phone:479-484-7575
Practice Address - Fax:479-484-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C616Medicare ID - Type UnspecifiedID NUMBER