Provider Demographics
NPI:1780843466
Name:BACK 2 BACK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BACK 2 BACK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OHARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-391-2771
Mailing Address - Street 1:1719 MOUNT VERNON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4268
Mailing Address - Country:US
Mailing Address - Phone:770-391-2771
Mailing Address - Fax:770-391-2772
Practice Address - Street 1:1719 MOUNT VERNON RD
Practice Address - Street 2:SUITE B
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4268
Practice Address - Country:US
Practice Address - Phone:770-391-2771
Practice Address - Fax:770-391-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO0831111N00000X
GACHIRO08142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty