Provider Demographics
NPI:1023131505
Name:THE BACK DOCTORS OF CONCORD
Entity type:Organization
Organization Name:THE BACK DOCTORS OF CONCORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:RUNCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-685-0335
Mailing Address - Street 1:2975 TREAT BLVD
Mailing Address - Street 2:A-2
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3601
Mailing Address - Country:US
Mailing Address - Phone:925-685-0335
Mailing Address - Fax:925-685-8883
Practice Address - Street 1:2975 TREAT BLVD
Practice Address - Street 2:A-2
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3601
Practice Address - Country:US
Practice Address - Phone:925-685-0335
Practice Address - Fax:925-685-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0168450Medicare UPIN
CADC-29529Medicare ID - Type Unspecified
CADC0168450Medicare ID - Type Unspecified
CAU42197Medicare UPIN
CAV02907Medicare UPIN
CADC-20739Medicare ID - Type Unspecified