Provider Demographics
NPI:1063406379
Name:BACK TO HEALTH PLUS, PLLC
Entity type:Organization
Organization Name:BACK TO HEALTH PLUS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CADWALLADER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-630-3564
Mailing Address - Street 1:3757 MEADOWBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-2872
Mailing Address - Country:US
Mailing Address - Phone:608-630-3564
Mailing Address - Fax:608-630-3564
Practice Address - Street 1:3757 MEADOWBROOKE CIR
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-2872
Practice Address - Country:US
Practice Address - Phone:608-630-3564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3150785OtherBLUE CROSS BLUE SHEILD
TN3971330Medicare ID - Type Unspecified