Provider Demographics
NPI:1376845461
Name:BACK ON TRACK CHIROPRACTIC P C
Entity Type:Organization
Organization Name:BACK ON TRACK CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-922-0421
Mailing Address - Street 1:3335 S AIRPORT RD W
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7928
Mailing Address - Country:US
Mailing Address - Phone:231-922-0421
Mailing Address - Fax:231-922-9904
Practice Address - Street 1:3335 S AIRPORT RD W
Practice Address - Street 2:SUITE 6A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7928
Practice Address - Country:US
Practice Address - Phone:231-922-0421
Practice Address - Fax:231-922-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty