Provider Demographics
NPI:1205003522
Name:BACK TO HEALTH CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BURLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-962-8277
Mailing Address - Street 1:1605 COUNTRY LAKES DR
Mailing Address - Street 2:#204
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9038
Mailing Address - Country:US
Mailing Address - Phone:630-962-8277
Mailing Address - Fax:
Practice Address - Street 1:1605 COUNTRY LAKES DR
Practice Address - Street 2:#204
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9038
Practice Address - Country:US
Practice Address - Phone:630-962-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011023305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization