Provider Demographics
NPI:1780229112
Name:BACK TO WELLNESS MEDICAL CENTER
Entity Type:Organization
Organization Name:BACK TO WELLNESS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HELMUT
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:EICHNER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:541-633-6563
Mailing Address - Street 1:2669 NE TWIN KNOLLS DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6206
Mailing Address - Country:US
Mailing Address - Phone:541-633-6563
Mailing Address - Fax:541-550-2218
Practice Address - Street 1:2669 NE TWIN KNOLLS DR STE 208
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6206
Practice Address - Country:US
Practice Address - Phone:541-633-6563
Practice Address - Fax:541-550-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500665892Medicaid