Provider Demographics
NPI:1922421668
Name:BACK AND NECK PAIN RELIEF CENTER
Entity Type:Organization
Organization Name:BACK AND NECK PAIN RELIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:THIRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-373-1563
Mailing Address - Street 1:1223 W MAIN ST
Mailing Address - Street 2:NUMBER 292
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1942
Mailing Address - Country:US
Mailing Address - Phone:608-373-1563
Mailing Address - Fax:
Practice Address - Street 1:1223 W MAIN ST
Practice Address - Street 2:NUMBER 292
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1942
Practice Address - Country:US
Practice Address - Phone:608-373-1563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2265-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty