Provider Demographics
NPI:1922245836
Name:BACK TO HEALTH WELLNESS CENTER, P.C,
Entity Type:Organization
Organization Name:BACK TO HEALTH WELLNESS CENTER, P.C,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-326-5100
Mailing Address - Street 1:2504 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5241
Mailing Address - Country:US
Mailing Address - Phone:219-326-5100
Mailing Address - Fax:219-326-0180
Practice Address - Street 1:2504 MONROE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5241
Practice Address - Country:US
Practice Address - Phone:219-326-5100
Practice Address - Fax:219-326-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty