Provider Demographics
NPI:1629571211
Name:BACK 2 HEALTH LLC
Entity type:Organization
Organization Name:BACK 2 HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-919-1333
Mailing Address - Street 1:819 FOREST PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2281
Mailing Address - Country:US
Mailing Address - Phone:678-919-1333
Mailing Address - Fax:404-500-3381
Practice Address - Street 1:819 FOREST PKWY STE B
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2281
Practice Address - Country:US
Practice Address - Phone:678-919-1333
Practice Address - Fax:404-500-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007062111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA856208049AMedicaid