Provider Demographics
NPI:1780788877
Name:WESTERVILLE BACK CARE CENTER INC
Entity type:Organization
Organization Name:WESTERVILLE BACK CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:SIFFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-794-0200
Mailing Address - Street 1:107 A COMMERCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6057
Mailing Address - Country:US
Mailing Address - Phone:614-794-0200
Mailing Address - Fax:614-794-0200
Practice Address - Street 1:107 A COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6057
Practice Address - Country:US
Practice Address - Phone:614-794-0200
Practice Address - Fax:614-794-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9254561OtherUNSPECIFIED
OH9254561Medicare PIN