Provider Demographics
NPI:1275720989
Name:BACKBONE OF HEALTHCARE PC
Entity Type:Organization
Organization Name:BACKBONE OF HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:HACKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-872-2171
Mailing Address - Street 1:606 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2408
Mailing Address - Country:US
Mailing Address - Phone:308-872-2171
Mailing Address - Fax:308-872-6093
Practice Address - Street 1:606 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2408
Practice Address - Country:US
Practice Address - Phone:308-872-2171
Practice Address - Fax:308-872-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
099316Medicare PIN