Provider Demographics
NPI:1639422611
Name:BACKPRO CHIROPRACTIC & NUTRITION, P.C.
Entity Type:Organization
Organization Name:BACKPRO CHIROPRACTIC & NUTRITION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:602-992-4444
Mailing Address - Street 1:PO BOX 72959
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1033
Mailing Address - Country:US
Mailing Address - Phone:602-992-4444
Mailing Address - Fax:602-992-4004
Practice Address - Street 1:3141 E BEARDSLEY RD
Practice Address - Street 2:SUITE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4771
Practice Address - Country:US
Practice Address - Phone:602-992-4444
Practice Address - Fax:602-992-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0934900OtherBCBS OF AZ
Z60382OtherMEDICARE PTAN
U56538Medicare UPIN