Provider Demographics
NPI:1205857992
Name:BACK TO LIFE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:BACK TO LIFE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-834-2600
Mailing Address - Street 1:5511 EDMONDSON PIKE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5870
Mailing Address - Country:US
Mailing Address - Phone:615-834-2600
Mailing Address - Fax:615-834-2662
Practice Address - Street 1:5511 EDMONDSON PIKE
Practice Address - Street 2:SUITE 205
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5870
Practice Address - Country:US
Practice Address - Phone:615-834-2600
Practice Address - Fax:615-834-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2059 AND 2064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4116805OtherBCBS OF TN
TN3733079Medicare ID - Type Unspecified