Provider Demographics
NPI:1932207206
Name:BACK-2-LIFE OF FLORIDEA
Entity Type:Organization
Organization Name:BACK-2-LIFE OF FLORIDEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-797-0500
Mailing Address - Street 1:2905 RIGSBY LN
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4828
Mailing Address - Country:US
Mailing Address - Phone:727-797-0500
Mailing Address - Fax:727-797-0050
Practice Address - Street 1:2905 RIGSBY LN
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4828
Practice Address - Country:US
Practice Address - Phone:727-797-0500
Practice Address - Fax:727-797-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9772111N00000X
FLME 97457171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99652OtherBCBS GROUP NUMBER
FL1447270566OtherGROTEKE NPI #
FL9067913OtherCIGNA
FL1147626OtherFIRST HEALTH
FL9067913OtherDR. ERIC GROTEKE
FL71494OtherBLUE CROSS/BLUE SHIELD
FLME97457OtherRHODES LICENSE #
FL1038157OtherAMERICAN SPECIALTY HEALTH
FL656080OtherACN GROUP
FLCH8146OtherSTAFFORD'S LICENSE
FL1750349301OtherRHODES NPI #
FL1770650574OtherSTAFFORD'S NPI #
FL656080OtherUNITED HEALTH CARE
FLCH8772OtherGROTEKE'S LICENSE #
FLCH8772OtherGROTEKE'S LICENSE #
FL1770650574OtherSTAFFORD'S NPI #
FL9067913OtherCIGNA
FL71494ZMedicare ID - Type UnspecifiedDR. ERIC GROTEKE
FLCH8772OtherGROTEKE'S LICENSE #