Provider Demographics
NPI:1407952948
Name:BACK TO HEALTH CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:WILMOT
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-537-7777
Mailing Address - Street 1:146 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1892
Mailing Address - Country:US
Mailing Address - Phone:812-537-7777
Mailing Address - Fax:888-871-3404
Practice Address - Street 1:146 WALNUT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1892
Practice Address - Country:US
Practice Address - Phone:812-537-7777
Practice Address - Fax:888-871-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000234A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200178820 AMedicaid
U65517Medicare UPIN
IN200178820 AMedicaid