Provider Demographics
NPI:1851621783
Name:BACK TO HEALTH, LLC
Entity Type:Organization
Organization Name:BACK TO HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-752-7521
Mailing Address - Street 1:512 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6405
Mailing Address - Country:US
Mailing Address - Phone:508-752-7521
Mailing Address - Fax:508-798-3418
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6405
Practice Address - Country:US
Practice Address - Phone:508-752-7521
Practice Address - Fax:508-798-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45247Medicare PIN
MAU75354Medicare UPIN