Provider Demographics
NPI:1821021049
Name:BACK TO HEALTH FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BACK TO HEALTH FAMILY CHIROPRACTIC INC
Other - Org Name:MATTHEWS FAMILY CHIROPRACTIC INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-393-9609
Mailing Address - Street 1:1113 NORTHVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8525
Mailing Address - Country:US
Mailing Address - Phone:937-393-9609
Mailing Address - Fax:937-393-9606
Practice Address - Street 1:1113 NORTHVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8525
Practice Address - Country:US
Practice Address - Phone:937-393-9609
Practice Address - Fax:937-393-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1957111N00000X
OH1539111N00000X
OH3615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9333581Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER