Provider Demographics
NPI:1407954704
Name:BACK TO HEALTH WELLNESS, INC
Entity Type:Organization
Organization Name:BACK TO HEALTH WELLNESS, INC
Other - Org Name:ST. MARYS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-437-6162
Mailing Address - Street 1:503 E. BERTRAND
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536
Mailing Address - Country:US
Mailing Address - Phone:785-437-6162
Mailing Address - Fax:785-437-6197
Practice Address - Street 1:503 E. BERTRAND
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536
Practice Address - Country:US
Practice Address - Phone:785-437-6162
Practice Address - Fax:785-437-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060074Medicare ID - Type UnspecifiedST. MARYS CHIROPRACTIC