Provider Demographics
NPI:1972254415
Name:BACKBONE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BACKBONE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-916-4456
Mailing Address - Street 1:17230 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-8681
Mailing Address - Country:US
Mailing Address - Phone:219-916-4456
Mailing Address - Fax:
Practice Address - Street 1:9921 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2041
Practice Address - Country:US
Practice Address - Phone:260-218-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center