Provider Demographics
NPI:1982612966
Name:BACK & NECK CARE CENTER LLC
Entity Type:Organization
Organization Name:BACK & NECK CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MIGLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-676-1321
Mailing Address - Street 1:7074 PINECREST AVENUE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904
Mailing Address - Country:US
Mailing Address - Phone:321-676-1321
Mailing Address - Fax:321-952-4128
Practice Address - Street 1:7074 PINECREST AVENUE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904
Practice Address - Country:US
Practice Address - Phone:321-676-1321
Practice Address - Fax:321-952-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22042OtherBCBS FL
FL22042OtherBCBS FL