Provider Demographics
NPI:1508062183
Name:BACKSTRONG NON-SURGICAL REHAB CLINIC
Entity Type:Organization
Organization Name:BACKSTRONG NON-SURGICAL REHAB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CASTANET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-558-4015
Mailing Address - Street 1:2176 BRIARLAKE TRCE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3670
Mailing Address - Country:US
Mailing Address - Phone:404-558-4015
Mailing Address - Fax:770-908-0463
Practice Address - Street 1:2771 LAWRENCEVILLE HWY STE 101
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2500
Practice Address - Country:US
Practice Address - Phone:404-558-4015
Practice Address - Fax:770-908-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACH002767261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCJPBMedicare ID - Type Unspecified
GA6270360001Medicare NSC
GAV09257Medicare UPIN