Provider Demographics
NPI:1316117591
Name:BACK TO HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-339-7788
Mailing Address - Street 1:450 CHAUNCY ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1198
Mailing Address - Country:US
Mailing Address - Phone:508-339-7788
Mailing Address - Fax:508-339-2823
Practice Address - Street 1:450 CHAUNCY ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1198
Practice Address - Country:US
Practice Address - Phone:508-339-7788
Practice Address - Fax:508-339-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2824111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty