Provider Demographics
NPI:1740899475
Name:BACK 2 WORK CLINICS
Entity type:Organization
Organization Name:BACK 2 WORK CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-965-2262
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-0382
Mailing Address - Country:US
Mailing Address - Phone:208-576-4696
Mailing Address - Fax:208-963-3299
Practice Address - Street 1:950 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6020
Practice Address - Country:US
Practice Address - Phone:208-965-2262
Practice Address - Fax:208-963-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate HealthGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine