Provider Demographics
NPI:1710251269
Name:BACK TO BACK CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK TO BACK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERONEA
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:LAHANN-CHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-269-2225
Mailing Address - Street 1:1343 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-3801
Mailing Address - Country:US
Mailing Address - Phone:408-269-2225
Mailing Address - Fax:408-979-7878
Practice Address - Street 1:1343 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-3801
Practice Address - Country:US
Practice Address - Phone:408-269-2225
Practice Address - Fax:408-979-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU87510Medicare UPIN
CADC0267570Medicare PIN