Provider Demographics
NPI:1902094790
Name:BACKWORKS CHIROPRACTIC AND WELLNESS LLC
Entity Type:Organization
Organization Name:BACKWORKS CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-624-1935
Mailing Address - Street 1:907 N HARRIS DR STE B
Mailing Address - Street 2:PO BOX 678
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-2734
Mailing Address - Country:US
Mailing Address - Phone:573-624-1935
Mailing Address - Fax:573-624-9131
Practice Address - Street 1:907 N HARRIS DR STE B
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2734
Practice Address - Country:US
Practice Address - Phone:573-624-1935
Practice Address - Fax:573-624-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty