Provider Demographics
NPI:1750692125
Name:NECK & BACK CENTER
Entity type:Organization
Organization Name:NECK & BACK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-985-9048
Mailing Address - Street 1:4100 W 15TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5801
Mailing Address - Country:US
Mailing Address - Phone:972-985-9048
Mailing Address - Fax:972-596-7570
Practice Address - Street 1:4100 W 15TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5801
Practice Address - Country:US
Practice Address - Phone:972-985-9048
Practice Address - Fax:972-596-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty