Provider Demographics
NPI:1851571772
Name:BACK TO ACTION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BACK TO ACTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DREESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-670-2600
Mailing Address - Street 1:6603 220TH ST SW
Mailing Address - Street 2:STE 100
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043
Mailing Address - Country:US
Mailing Address - Phone:425-670-2600
Mailing Address - Fax:425-778-7073
Practice Address - Street 1:6603 220TH ST SW
Practice Address - Street 2:STE 100
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043
Practice Address - Country:US
Practice Address - Phone:425-670-2600
Practice Address - Fax:425-778-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002267111N00000X
WACH00034001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty