Provider Demographics
NPI:1881232056
Name:BACKCOUNTRY SPINE AND SPORT INC
Entity Type:Organization
Organization Name:BACKCOUNTRY SPINE AND SPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-954-5095
Mailing Address - Street 1:P.O. BOX 181
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:16851
Mailing Address - Country:US
Mailing Address - Phone:814-954-5095
Mailing Address - Fax:
Practice Address - Street 1:140 MARY STREET
Practice Address - Street 2:UNIT B
Practice Address - City:LEMONT
Practice Address - State:PA
Practice Address - Zip Code:16851
Practice Address - Country:US
Practice Address - Phone:814-954-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty