Provider Demographics
NPI:1235588369
Name:BACK PAIN RELIEF CENTER, LLC
Entity Type:Organization
Organization Name:BACK PAIN RELIEF CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAIMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-804-8100
Mailing Address - Street 1:675 WACHESAW RD
Mailing Address - Street 2:MALLORY CENTER UNIT D
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5681
Mailing Address - Country:US
Mailing Address - Phone:843-804-8100
Mailing Address - Fax:843-651-5422
Practice Address - Street 1:675 WACHESAW RD
Practice Address - Street 2:MALLORY CENTER UNIT D
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5681
Practice Address - Country:US
Practice Address - Phone:843-804-8100
Practice Address - Fax:843-651-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty