Provider Demographics
NPI:1033668124
Name:BACK TO ACTION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK TO ACTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:720-326-8545
Mailing Address - Street 1:4344 WOODLANDS BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2801
Mailing Address - Country:US
Mailing Address - Phone:720-326-8545
Mailing Address - Fax:
Practice Address - Street 1:4344 WOODLANDS BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2801
Practice Address - Country:US
Practice Address - Phone:720-326-8545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COEL.2786571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty