Provider Demographics
NPI:1922421015
Name:BACK BY DESIGN, PLLC
Entity Type:Organization
Organization Name:BACK BY DESIGN, PLLC
Other - Org Name:BACK BY DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-592-2778
Mailing Address - Street 1:928 W HIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:IOWA PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76367-1149
Mailing Address - Country:US
Mailing Address - Phone:940-592-2778
Mailing Address - Fax:940-592-2701
Practice Address - Street 1:928 W HIGHWAY ST
Practice Address - Street 2:
Practice Address - City:IOWA PARK
Practice Address - State:TX
Practice Address - Zip Code:76367-1149
Practice Address - Country:US
Practice Address - Phone:940-592-2778
Practice Address - Fax:940-592-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046455402Medicaid
TXP00192167Medicare PIN