Provider Demographics
NPI:1508932948
Name:BACK TO HEALTH CMC INC
Entity Type:Organization
Organization Name:BACK TO HEALTH CMC INC
Other - Org Name:BACK TO HEALTH INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-544-8881
Mailing Address - Street 1:PO BOX 52148
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-2148
Mailing Address - Country:US
Mailing Address - Phone:919-544-8881
Mailing Address - Fax:919-544-8889
Practice Address - Street 1:6224 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 106B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6288
Practice Address - Country:US
Practice Address - Phone:919-544-8881
Practice Address - Fax:919-544-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085FROtherBCBS
NC621714OtherACN
NC621714OtherCIGNA
NC085FROtherCNC
NC890839WMedicaid
NC621714OtherUNITED HEALTH CARE
NC621714OtherUNITED HEALTH CARE
NC621714OtherCIGNA