Provider Demographics
NPI:1770721573
Name:GOTCHA BACK, LLC
Entity type:Organization
Organization Name:GOTCHA BACK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-478-1443
Mailing Address - Street 1:1309 VEALE ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4609
Mailing Address - Country:US
Mailing Address - Phone:302-478-1443
Mailing Address - Fax:302-478-1442
Practice Address - Street 1:1309 VEALE RD
Practice Address - Street 2:SUITE 12
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4609
Practice Address - Country:US
Practice Address - Phone:302-478-1443
Practice Address - Fax:302-478-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty