Provider Demographics
NPI:1407806771
Name:NECK AND BACK MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:NECK AND BACK MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-859-6600
Mailing Address - Street 1:26072 MERIT CIR
Mailing Address - Street 2:119
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7015
Mailing Address - Country:US
Mailing Address - Phone:949-859-6600
Mailing Address - Fax:949-859-6600
Practice Address - Street 1:26072 MERIT CIR
Practice Address - Street 2:119
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7015
Practice Address - Country:US
Practice Address - Phone:949-859-6600
Practice Address - Fax:949-859-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65340ZOtherBLUE SHIELD
CAW15880Medicare ID - Type UnspecifiedMEDICARE