Provider Demographics
NPI:1295874667
Name:A BACK & NECK PAIN CENTER INC
Entity type:Organization
Organization Name:A BACK & NECK PAIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-448-8404
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834
Mailing Address - Country:US
Mailing Address - Phone:812-448-8404
Mailing Address - Fax:812-443-1427
Practice Address - Street 1:501 E US HWY 40
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834
Practice Address - Country:US
Practice Address - Phone:812-448-8404
Practice Address - Fax:812-443-1427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A BACK & NECK PAIN CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000514A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U24182Medicare UPIN
IN130760Medicare ID - Type Unspecified