Provider Demographics
NPI:1275649667
Name:BACK ON TRACK CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK ON TRACK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:FARQUHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-838-1120
Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:766 E PITTSBURGH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2678
Practice Address - Country:US
Practice Address - Phone:724-838-1120
Practice Address - Fax:724-838-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008034L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV02250Medicare UPIN