Provider Demographics
NPI:1487134508
Name:BACK & BEYOND LLC
Entity type:Organization
Organization Name:BACK & BEYOND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-750-8900
Mailing Address - Street 1:1419 E BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6168
Mailing Address - Country:US
Mailing Address - Phone:708-691-5823
Mailing Address - Fax:
Practice Address - Street 1:1655 W CHANDLER BLVD STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6284
Practice Address - Country:US
Practice Address - Phone:708-691-5823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty