Provider Demographics
NPI:1013082395
Name:BACK TO HEALTH CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-382-7782
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:HARMONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16422-0366
Mailing Address - Country:US
Mailing Address - Phone:814-382-7782
Mailing Address - Fax:814-382-7782
Practice Address - Street 1:10889 PLUM ST.
Practice Address - Street 2:
Practice Address - City:HARMONSBURG
Practice Address - State:PA
Practice Address - Zip Code:16422-0366
Practice Address - Country:US
Practice Address - Phone:814-382-7782
Practice Address - Fax:814-382-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019424700002Medicaid
PA0019424700002Medicaid