Provider Demographics
NPI:1831534130
Name:BACK TO BALANCE CHIROPRACTIC AND WELLNESS PLLC
Entity type:Organization
Organization Name:BACK TO BALANCE CHIROPRACTIC AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-706-5816
Mailing Address - Street 1:2739 S 5600 W STE 170
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-4633
Mailing Address - Country:US
Mailing Address - Phone:801-966-5106
Mailing Address - Fax:855-421-3750
Practice Address - Street 1:2739 S 5600 W STE 170
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-4633
Practice Address - Country:US
Practice Address - Phone:801-966-5106
Practice Address - Fax:855-421-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8622553-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty