Provider Demographics
NPI:1205146388
Name:BACK TO THE FUTURE CHIROPRACTIC
Entity type:Organization
Organization Name:BACK TO THE FUTURE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCALISI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-863-3316
Mailing Address - Street 1:7687 FRONTAGE RD
Mailing Address - Street 2:INSIDE CHAMPIONS FITNESS CENTER
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8742
Mailing Address - Country:US
Mailing Address - Phone:315-863-3316
Mailing Address - Fax:315-452-5971
Practice Address - Street 1:7687 FRONTAGE RD
Practice Address - Street 2:INSIDE CHAMPIONS FITNESS CENTER
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8742
Practice Address - Country:US
Practice Address - Phone:315-863-3316
Practice Address - Fax:315-452-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty