Provider Demographics
NPI:1891913349
Name:BACK TO HEALTH CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-892-0898
Mailing Address - Street 1:10880 175TH CT W
Mailing Address - Street 2:SUITE #120
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8781
Mailing Address - Country:US
Mailing Address - Phone:952-892-0898
Mailing Address - Fax:952-898-7626
Practice Address - Street 1:10880 175TH CT W
Practice Address - Street 2:SUITE #120
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8781
Practice Address - Country:US
Practice Address - Phone:952-892-0898
Practice Address - Fax:952-898-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty