Provider Demographics
NPI:1669754537
Name:BACK INTO HEALTH CHIROPRACTIC INC.
Entity type:Organization
Organization Name:BACK INTO HEALTH CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KUCHLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:904-220-6461
Mailing Address - Street 1:13121 ATLANTIC BLVD.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3125
Mailing Address - Country:US
Mailing Address - Phone:904-220-6461
Mailing Address - Fax:904-220-8953
Practice Address - Street 1:13121 ATLANTIC BLVD.
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3125
Practice Address - Country:US
Practice Address - Phone:904-220-6461
Practice Address - Fax:904-220-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty