Provider Demographics
NPI:1891460754
Name:BACK PAIN SOLUTIONS CLINIC INC
Entity Type:Organization
Organization Name:BACK PAIN SOLUTIONS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:280-967-5608
Mailing Address - Street 1:827 W PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8459
Mailing Address - Country:US
Mailing Address - Phone:208-660-9378
Mailing Address - Fax:208-758-8527
Practice Address - Street 1:827 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8459
Practice Address - Country:US
Practice Address - Phone:208-660-9378
Practice Address - Fax:208-758-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty