Provider Demographics
NPI:1902892888
Name:BACK ISSUES PC INC
Entity Type:Organization
Organization Name:BACK ISSUES PC INC
Other - Org Name:PATASKALA FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-964-2081
Mailing Address - Street 1:378 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8392
Mailing Address - Country:US
Mailing Address - Phone:740-964-2081
Mailing Address - Fax:614-656-4027
Practice Address - Street 1:378 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8392
Practice Address - Country:US
Practice Address - Phone:740-964-2081
Practice Address - Fax:614-656-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2406597Medicaid
OHKO4117Medicare ID - Type Unspecified
OH2406597Medicaid