Provider Demographics
NPI:1023331345
Name:BACK TO BACK CHIROPRACTIC CLINIC, PC
Entity type:Organization
Organization Name:BACK TO BACK CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-838-0223
Mailing Address - Street 1:1050 31ST AVE SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-2005
Mailing Address - Country:US
Mailing Address - Phone:701-838-0223
Mailing Address - Fax:701-838-0238
Practice Address - Street 1:1050 31ST AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-2005
Practice Address - Country:US
Practice Address - Phone:701-838-0223
Practice Address - Fax:701-838-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14965Medicaid