Provider Demographics
NPI:1427329507
Name:BACK II GOOD INJURY & WELLNESS CENTER
Entity type:Organization
Organization Name:BACK II GOOD INJURY & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-328-0193
Mailing Address - Street 1:3939 E HIGHWAY 80
Mailing Address - Street 2:SUITE 223
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3359
Mailing Address - Country:US
Mailing Address - Phone:469-328-0193
Mailing Address - Fax:
Practice Address - Street 1:3939 E HIGHWAY 80
Practice Address - Street 2:SUITE 223
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3359
Practice Address - Country:US
Practice Address - Phone:469-328-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11575111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty