Provider Demographics
NPI:1306960927
Name:BACK TO INTELLIGENT DESIGN, LLC
Entity type:Organization
Organization Name:BACK TO INTELLIGENT DESIGN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-793-1006
Mailing Address - Street 1:1201 SOCIETY DR
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-1777
Mailing Address - Country:US
Mailing Address - Phone:302-793-1006
Mailing Address - Fax:302-793-1636
Practice Address - Street 1:1201 SOCIETY DR
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-1777
Practice Address - Country:US
Practice Address - Phone:302-793-1006
Practice Address - Fax:302-793-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFL-0000557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU68145Medicare UPIN