Provider Demographics
NPI:1598288839
Name:NICHOLAS JOHN BACKHAUS
Entity Type:Organization
Organization Name:NICHOLAS JOHN BACKHAUS
Other - Org Name:BACKHAUS FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INDEPENDENT CONTRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BACKHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-249-1739
Mailing Address - Street 1:2323 MOUNT VERNON RD SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3439
Mailing Address - Country:US
Mailing Address - Phone:319-363-2273
Mailing Address - Fax:
Practice Address - Street 1:2323 MOUNT VERNON RD SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-3439
Practice Address - Country:US
Practice Address - Phone:319-289-8300
Practice Address - Fax:319-289-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty