Provider Demographics
NPI:1942475561
Name:BACK & NECK CENTER P.C.
Entity type:Organization
Organization Name:BACK & NECK CENTER P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANG.
Authorized Official - Prefix:MISS
Authorized Official - First Name:BERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDBURROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-526-5020
Mailing Address - Street 1:2001 N. 4TH ST.
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2001
Mailing Address - Country:US
Mailing Address - Phone:928-526-5020
Mailing Address - Fax:928-527-4965
Practice Address - Street 1:2001 N. 4TH ST.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2001
Practice Address - Country:US
Practice Address - Phone:928-526-5020
Practice Address - Fax:928-527-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty