Provider Demographics
NPI:1144466962
Name:LIFEBACK CHIROPRACTIC PLC
Entity type:Organization
Organization Name:LIFEBACK CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WOJCIECHOWSKI
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:405-328-1201
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:EARLSBORO
Mailing Address - State:OK
Mailing Address - Zip Code:74840-0235
Mailing Address - Country:US
Mailing Address - Phone:405-328-1201
Mailing Address - Fax:
Practice Address - Street 1:1101 N HARRISON ST STE B
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5205
Practice Address - Country:US
Practice Address - Phone:405-328-1201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3848305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service