Provider Demographics
NPI:1427230549
Name:NECK & BACK CARE CENTER INC
Entity Type:Organization
Organization Name:NECK & BACK CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:OLIVERIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-563-5055
Mailing Address - Street 1:912 NE 5TH ST
Mailing Address - Street 2:HWY 44
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4444
Mailing Address - Country:US
Mailing Address - Phone:352-563-5055
Mailing Address - Fax:352-563-5069
Practice Address - Street 1:912 NE 5TH ST
Practice Address - Street 2:HWY 44
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4444
Practice Address - Country:US
Practice Address - Phone:352-563-5055
Practice Address - Fax:352-563-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381129800Medicaid
FL55797OtherBCBS
FL1750303186OtherNPI INDIVIDUAL
FL1750303186OtherNPI INDIVIDUAL
FL381129800Medicaid