Provider Demographics
NPI:1306081633
Name:BACK-2-BACK CHIROPRACTIC
Entity type:Organization
Organization Name:BACK-2-BACK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-726-2225
Mailing Address - Street 1:3000 NW STUCKI PL
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7107
Mailing Address - Country:US
Mailing Address - Phone:503-726-2225
Mailing Address - Fax:
Practice Address - Street 1:3000 NW STUCKI PL
Practice Address - Street 2:SUITE 180
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7107
Practice Address - Country:US
Practice Address - Phone:503-726-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3700261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center