Provider Demographics
NPI:1952683757
Name:BACK TO HEALTH CHIROPRACTIC OF GRASS VALLEY
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC OF GRASS VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEBBY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MARGARETICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-273-4102
Mailing Address - Street 1:652 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7533
Mailing Address - Country:US
Mailing Address - Phone:530-273-4102
Mailing Address - Fax:530-273-6826
Practice Address - Street 1:652 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7533
Practice Address - Country:US
Practice Address - Phone:530-273-4102
Practice Address - Fax:530-273-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty