Provider Demographics
NPI:1346259025
Name:BACK TO HEALTH CHIROPRACTIC WELLNESS CENTER P.C.
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC WELLNESS CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WESTERBEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-546-3500
Mailing Address - Street 1:10990 CHICAGO DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-8100
Mailing Address - Country:US
Mailing Address - Phone:616-546-3500
Mailing Address - Fax:616-546-3501
Practice Address - Street 1:10990 CHICAGO DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-8100
Practice Address - Country:US
Practice Address - Phone:616-546-3500
Practice Address - Fax:616-546-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-G0-1176-0OtherBCBS BLUE CARE NETWORK