Provider Demographics
NPI:1346751484
Name:BACK TO NORMAL II LLC
Entity Type:Organization
Organization Name:BACK TO NORMAL II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CZERWEIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-310-7334
Mailing Address - Street 1:DEPT # 880237 PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:800-310-7334
Mailing Address - Fax:
Practice Address - Street 1:53 SADDLE ROWE LN
Practice Address - Street 2:
Practice Address - City:NORTH SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1271
Practice Address - Country:US
Practice Address - Phone:401-749-0539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12647204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty