Provider Demographics
NPI:1376879023
Name:BACK TO ROOTS CHIROPRACTIC AND NUTRITION
Entity Type:Organization
Organization Name:BACK TO ROOTS CHIROPRACTIC AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSACN
Authorized Official - Phone:603-948-2121
Mailing Address - Street 1:PO BOX 1634
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03866-1634
Mailing Address - Country:US
Mailing Address - Phone:603-948-2121
Mailing Address - Fax:603-948-2162
Practice Address - Street 1:169 ROCHESTER HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1728
Practice Address - Country:US
Practice Address - Phone:603-948-2121
Practice Address - Fax:603-948-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH846-0809111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty