Provider Demographics
NPI:1578080867
Name:BACK 2 LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BACK 2 LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-792-2990
Mailing Address - Street 1:679 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1380
Mailing Address - Country:US
Mailing Address - Phone:508-792-2990
Mailing Address - Fax:
Practice Address - Street 1:679 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1380
Practice Address - Country:US
Practice Address - Phone:508-792-2990
Practice Address - Fax:508-792-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2295111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty