Provider Demographics
NPI:1548430820
Name:BACK TO HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-565-9500
Mailing Address - Street 1:3075 W 7800 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-2802
Mailing Address - Country:US
Mailing Address - Phone:801-565-9500
Mailing Address - Fax:801-304-7046
Practice Address - Street 1:3075 WEST 7800 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-2802
Practice Address - Country:US
Practice Address - Phone:801-565-9500
Practice Address - Fax:801-304-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292911-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00055915Medicare PIN