Provider Demographics
NPI:1336331651
Name:BACK OF AMERICA LTD.
Entity Type:Organization
Organization Name:BACK OF AMERICA LTD.
Other - Org Name:COMPASS CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:VALERIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-658-3660
Mailing Address - Street 1:1204 E. ALGONQUIN RD
Mailing Address - Street 2:BUILDING C SUITE A
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102
Mailing Address - Country:US
Mailing Address - Phone:847-658-3660
Mailing Address - Fax:847-658-5418
Practice Address - Street 1:1204 E. ALGONQUIN RD
Practice Address - Street 2:BUILDING C SUITE A
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102
Practice Address - Country:US
Practice Address - Phone:847-658-3660
Practice Address - Fax:847-658-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU77828Medicare UPIN
ILL86708Medicare PIN