Provider Demographics
NPI:1891963765
Name:BACK PAIN SOLUTIONS INC.
Entity Type:Organization
Organization Name:BACK PAIN SOLUTIONS INC.
Other - Org Name:JAY KENNEDY DC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KENNNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-267-5830
Mailing Address - Street 1:808 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15530-1539
Mailing Address - Country:US
Mailing Address - Phone:181-426-7830
Mailing Address - Fax:
Practice Address - Street 1:808 DIAMOND ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:PA
Practice Address - Zip Code:15530-1539
Practice Address - Country:US
Practice Address - Phone:181-426-7830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003949L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2058294OtherAETNA HMO/POS
PA216978OtherUPMC
PA1508429OtherGATEWAY
PA01162738Medicaid
PA4281751OtherAETNA PPO/POS
PA01162738Medicaid
PA216978OtherUPMC