Provider Demographics
NPI:1932360369
Name:BACK TO HEALTH, LLC
Entity Type:Organization
Organization Name:BACK TO HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-242-1402
Mailing Address - Street 1:45 ACADEMY ST
Mailing Address - Street 2:STE. 401
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2924
Mailing Address - Country:US
Mailing Address - Phone:973-242-1402
Mailing Address - Fax:
Practice Address - Street 1:45 ACADEMY ST
Practice Address - Street 2:STE. 401
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2924
Practice Address - Country:US
Practice Address - Phone:973-242-1402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC005560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1982701520OtherPROVIDER NPI
NJ090734Medicare PIN
NJVO4944Medicare UPIN