Provider Demographics
NPI:1669642203
Name:BACK & NECK PAIN CENTER PC
Entity Type:Organization
Organization Name:BACK & NECK PAIN CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-537-2564
Mailing Address - Street 1:509 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4720
Mailing Address - Country:US
Mailing Address - Phone:912-537-2564
Mailing Address - Fax:912-538-9391
Practice Address - Street 1:509 JACKSON ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4720
Practice Address - Country:US
Practice Address - Phone:912-537-2564
Practice Address - Fax:912-538-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO001572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6174OtherGRP
GAGRP6174OtherGRP