Provider Demographics
NPI:1962640698
Name:BACKLUND, JUSTIN D (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:D
Last Name:BACKLUND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14732 DURHAM CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7760
Mailing Address - Country:US
Mailing Address - Phone:612-384-6835
Mailing Address - Fax:
Practice Address - Street 1:14732 DURHAM CT
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7760
Practice Address - Country:US
Practice Address - Phone:612-384-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor