Provider Demographics
NPI:1851864177
Name:BACK2HEALTH CHIROPRACTIC WELLNESS
Entity Type:Organization
Organization Name:BACK2HEALTH CHIROPRACTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-480-2402
Mailing Address - Street 1:8183 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7441
Mailing Address - Country:US
Mailing Address - Phone:850-466-5924
Mailing Address - Fax:850-466-5965
Practice Address - Street 1:8183 KIPLING ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7441
Practice Address - Country:US
Practice Address - Phone:850-466-5924
Practice Address - Fax:850-466-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty