Provider Demographics
NPI:1518237700
Name:BACK TO WELLNESS CHIROPRACTIC LC
Entity Type:Organization
Organization Name:BACK TO WELLNESS CHIROPRACTIC LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PIOTR
Authorized Official - Last Name:LOZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-442-3190
Mailing Address - Street 1:1517 N ANKENY BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4120
Mailing Address - Country:US
Mailing Address - Phone:515-442-3190
Mailing Address - Fax:
Practice Address - Street 1:1517 NORTH ANKENY BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-442-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty