Provider Demographics
NPI:1780800524
Name:BACK ON TRACK REHABILITATION CENTER
Entity type:Organization
Organization Name:BACK ON TRACK REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOIDOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-230-8920
Mailing Address - Street 1:1246 32ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1649
Mailing Address - Country:US
Mailing Address - Phone:320-230-8920
Mailing Address - Fax:320-230-8922
Practice Address - Street 1:1246 32ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1649
Practice Address - Country:US
Practice Address - Phone:320-230-8920
Practice Address - Fax:320-230-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4468111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty