Provider Demographics
NPI:1700260254
Name:BACK & NECK CARE CENTER OF NORTH COUNTY LLC
Entity Type:Organization
Organization Name:BACK & NECK CARE CENTER OF NORTH COUNTY LLC
Other - Org Name:SEVEN HILLS CHIROPRACTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-838-2220
Mailing Address - Street 1:11638 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6723
Mailing Address - Country:US
Mailing Address - Phone:314-838-2220
Mailing Address - Fax:314-838-8161
Practice Address - Street 1:11638 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6723
Practice Address - Country:US
Practice Address - Phone:314-838-2220
Practice Address - Fax:314-838-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty