Provider Demographics
NPI:1235642075
Name:DEFENSIVE BACKS PLLC
Entity Type:Organization
Organization Name:DEFENSIVE BACKS PLLC
Other - Org Name:BRITTIAN CHIROPRACTIC CENTER PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERREN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BRITTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-416-1488
Mailing Address - Street 1:401 N EDGEWORTH ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2233
Mailing Address - Country:US
Mailing Address - Phone:336-676-5817
Mailing Address - Fax:
Practice Address - Street 1:401 N EDGEWORTH ST STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2233
Practice Address - Country:US
Practice Address - Phone:336-676-5817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRITTIAN CHIROPRACTIC CENTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-15
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty