Provider Demographics
NPI:1225034754
Name:BACK NORTH CHIROPRACTIC CARE PLC
Entity Type:Organization
Organization Name:BACK NORTH CHIROPRACTIC CARE PLC
Other - Org Name:BACK NORTH CHIROPRACTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-652-0015
Mailing Address - Street 1:1127 NORTH AVE
Mailing Address - Street 2:STE 21
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2756
Mailing Address - Country:US
Mailing Address - Phone:802-652-0015
Mailing Address - Fax:802-652-0016
Practice Address - Street 1:1127 NORTH AVE
Practice Address - Street 2:STE 21
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-2756
Practice Address - Country:US
Practice Address - Phone:802-652-0015
Practice Address - Fax:802-652-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4352646OtherCIGNA
VT98L1880OtherLANDMARK
VTBACK68321OtherBCBSVT
VTOVN3537Medicaid
VT4352646OtherCIGNA
VT98L1880OtherLANDMARK
VT=========OtherCOMPNET