Provider Demographics
NPI:1215146303
Name:BACK 2 LIFE OF FLORIDA
Entity type:Organization
Organization Name:BACK 2 LIFE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-688-8770
Mailing Address - Street 1:2905 RIGSBY LN
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4828
Mailing Address - Country:US
Mailing Address - Phone:727-797-0500
Mailing Address - Fax:727-797-0050
Practice Address - Street 1:1226 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5657
Practice Address - Country:US
Practice Address - Phone:352-688-8770
Practice Address - Fax:352-688-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8772111N00000X
FLCH8146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71494OtherBLUE CROSS BLUE SHIELD
FL1447270566OtherNPI NUMBER E GROTEKE
FL656080OtherUNITED HEALTH CARE
FL70112OtherBLUE CROSS BLUE SHIELD
FL1147626OtherFIRST HEALTH
FL1770650574OtherNPI NUMBER D STAFFORD
FL1038157OtherAMERICAN SPECIALTY HEALTH
FL9067913OtherCIGNA
FL70112OtherBLUE CROSS BLUE SHIELD
FL71494OtherBLUE CROSS BLUE SHIELD
FL71494OtherBLUE CROSS BLUE SHIELD
FLU64288Medicare UPIN
FL71494ZMedicare ID - Type UnspecifiedMEDICARE