Provider Demographics
NPI:1598065344
Name:ROGERS BACK TO HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:ROGERS BACK TO HEALTH CHIROPRACTIC
Other - Org Name:BACK TO HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-636-1108
Mailing Address - Street 1:2502 W OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3170
Mailing Address - Country:US
Mailing Address - Phone:479-636-1108
Mailing Address - Fax:479-636-1148
Practice Address - Street 1:2502 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3170
Practice Address - Country:US
Practice Address - Phone:479-636-1108
Practice Address - Fax:479-636-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185316718Medicaid
AR185316718Medicaid