Provider Demographics
NPI:1356476733
Name:BACK TO HEALTH CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNNEA
Authorized Official - Last Name:CHMIELEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-759-8006
Mailing Address - Street 1:10801 JOHNSTON RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7855
Mailing Address - Country:US
Mailing Address - Phone:704-759-8006
Mailing Address - Fax:704-759-8216
Practice Address - Street 1:10801 JOHNSTON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7855
Practice Address - Country:US
Practice Address - Phone:704-759-8006
Practice Address - Fax:704-759-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454208AMedicare ID - Type Unspecified
NCU86845Medicare UPIN