Provider Demographics
NPI:1881738821
Name:BACK TO HEALTH
Entity type:Organization
Organization Name:BACK TO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:PEABODY
Authorized Official - Last Name:PEABODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-469-4045
Mailing Address - Street 1:11081 COLLEGE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-5210
Mailing Address - Country:US
Mailing Address - Phone:913-469-4045
Mailing Address - Fax:
Practice Address - Street 1:11081 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2105
Practice Address - Country:US
Practice Address - Phone:913-469-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04622111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72A388Medicare ID - Type Unspecified
KSU47730Medicare UPIN