Provider Demographics
NPI:1811038979
Name:BACK TO HEALTH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-324-7098
Mailing Address - Street 1:15 DAIGLE LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-4173
Mailing Address - Country:US
Mailing Address - Phone:207-324-7098
Mailing Address - Fax:207-324-7098
Practice Address - Street 1:15 DAIGLE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-4173
Practice Address - Country:US
Practice Address - Phone:207-324-7098
Practice Address - Fax:207-324-7098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty