Provider Demographics
NPI:1336507615
Name:BATAVIA BACK & NECK LTD
Entity Type:Organization
Organization Name:BATAVIA BACK & NECK LTD
Other - Org Name:BATAVIA BACK & NECK CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DI CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-879-6459
Mailing Address - Street 1:34 N WATER ST # 201
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1986
Mailing Address - Country:US
Mailing Address - Phone:630-879-6459
Mailing Address - Fax:630-482-3093
Practice Address - Street 1:34 N WATER ST # 201
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1986
Practice Address - Country:US
Practice Address - Phone:630-879-6459
Practice Address - Fax:630-482-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty