Provider Demographics
NPI:1376692764
Name:BACK TO NORMAL CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BACK TO NORMAL CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SWIATOSLAW
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PADUCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-317-6756
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-0253
Mailing Address - Country:US
Mailing Address - Phone:978-317-6756
Mailing Address - Fax:978-412-9099
Practice Address - Street 1:78 CENTRAL ST
Practice Address - Street 2:UNIT 3
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1965
Practice Address - Country:US
Practice Address - Phone:978-317-6756
Practice Address - Fax:978-412-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1376692764OtherNPPES
MAY39686OtherBCBSMA
MA1851379721OtherNPPES
MATX7270Medicare PIN
MAY49100Medicare PIN
MA1851379721OtherNPPES
MAU28662Medicare UPIN
MAY36186Medicare ID - Type UnspecifiedS. ALEXANDER PADUCHAK, DC