Provider Demographics
NPI:1245350768
Name:BACK, HILARY (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:HILARY
Middle Name:
Last Name:BACK
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-2012
Mailing Address - Country:US
Mailing Address - Phone:970-963-6500
Mailing Address - Fax:970-963-2950
Practice Address - Street 1:20 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2012
Practice Address - Country:US
Practice Address - Phone:970-963-6500
Practice Address - Fax:970-963-2950
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO637171100000X
OR1088175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath