Provider Demographics
NPI:1669409926
Name:BACK TO HEALTH CENTER LLC
Entity type:Organization
Organization Name:BACK TO HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:REY
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-262-8358
Mailing Address - Street 1:45-696 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2034
Mailing Address - Country:US
Mailing Address - Phone:808-235-0729
Mailing Address - Fax:808-263-3958
Practice Address - Street 1:45-696 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2034
Practice Address - Country:US
Practice Address - Phone:808-235-0729
Practice Address - Fax:808-263-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102435Medicare PIN