Provider Demographics
NPI:1558638569
Name:BACK TO WOW
Entity Type:Organization
Organization Name:BACK TO WOW
Other - Org Name:THRIVE LANCASTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KYLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-517-8960
Mailing Address - Street 1:2106 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2427
Mailing Address - Country:US
Mailing Address - Phone:717-517-8960
Mailing Address - Fax:717-431-6649
Practice Address - Street 1:2106 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2427
Practice Address - Country:US
Practice Address - Phone:717-517-8960
Practice Address - Fax:717-431-6649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE LANCASTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-18
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 10096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty