Provider Demographics
NPI:1104097393
Name:BACK TO HEALTH CHIROPRACTIC, P.C
Entity type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MANDRACCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-605-2225
Mailing Address - Street 1:6659 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3125
Mailing Address - Country:US
Mailing Address - Phone:718-605-2225
Mailing Address - Fax:718-966-5630
Practice Address - Street 1:6659 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3125
Practice Address - Country:US
Practice Address - Phone:718-605-2225
Practice Address - Fax:718-966-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty