Provider Demographics
NPI:1336393719
Name:BACK RESTORATION AND WELLNESS
Entity Type:Organization
Organization Name:BACK RESTORATION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRECOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-943-9355
Mailing Address - Street 1:2237 W PARKER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7800
Mailing Address - Country:US
Mailing Address - Phone:972-943-9355
Mailing Address - Fax:972-943-9672
Practice Address - Street 1:2237 W PARKER RD
Practice Address - Street 2:SUITE F
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7800
Practice Address - Country:US
Practice Address - Phone:972-943-9355
Practice Address - Fax:972-943-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9475261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain