Provider Demographics
NPI:1538365564
Name:BACK TO HEALTH
Entity type:Organization
Organization Name:BACK TO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-271-0353
Mailing Address - Street 1:8349 CROSSLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8483
Mailing Address - Country:US
Mailing Address - Phone:334-271-0353
Mailing Address - Fax:334-271-3012
Practice Address - Street 1:8349 CROSSLAND LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8483
Practice Address - Country:US
Practice Address - Phone:334-271-0353
Practice Address - Fax:334-271-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU50057Medicare UPIN