Provider Demographics
NPI:1932310893
Name:BACK WELLNESS CENTERS, INC.
Entity Type:Organization
Organization Name:BACK WELLNESS CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-781-7825
Mailing Address - Street 1:3765 S. BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:ENGELWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113
Mailing Address - Country:US
Mailing Address - Phone:303-781-7825
Mailing Address - Fax:303-781-7826
Practice Address - Street 1:3765 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3611
Practice Address - Country:US
Practice Address - Phone:303-781-7825
Practice Address - Fax:303-781-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C13073Medicare ID - Type Unspecified
COU47370Medicare UPIN