Provider Demographics
NPI:1003087164
Name:BACK TO HEALTH P.C.
Entity type:Organization
Organization Name:BACK TO HEALTH P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MOZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-975-0099
Mailing Address - Street 1:PO BOX 3563
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3563
Mailing Address - Country:US
Mailing Address - Phone:423-975-0099
Mailing Address - Fax:423-975-0996
Practice Address - Street 1:1617 W MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4903
Practice Address - Country:US
Practice Address - Phone:423-975-0099
Practice Address - Fax:423-975-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty