Provider Demographics
NPI:1821343260
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:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-254-7988
Mailing Address - Street 1:605 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-1013
Mailing Address - Country:US
Mailing Address - Phone:719-254-7988
Mailing Address - Fax:719-254-7908
Practice Address - Street 1:605 N 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-1013
Practice Address - Country:US
Practice Address - Phone:719-254-7988
Practice Address - Fax:719-254-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty