Provider Demographics
NPI:1275566077
Name:BACK TO HEALTH PC
Entity Type:Organization
Organization Name:BACK TO HEALTH PC
Other - Org Name:BOWMAN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-630-2225
Mailing Address - Street 1:1727 W JESSE JAMES RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1846
Mailing Address - Country:US
Mailing Address - Phone:816-630-2225
Mailing Address - Fax:816-637-2225
Practice Address - Street 1:1727 W JESSE JAMES RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1846
Practice Address - Country:US
Practice Address - Phone:816-630-2225
Practice Address - Fax:816-637-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33757039OtherBLUE CROSS BLUE SHIELD
S49C986Medicare ID - Type Unspecified
U99558Medicare UPIN