Provider Demographics
NPI:1699056143
Name:BACK2BACK CHIROPRACTIC & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:BACK2BACK CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-777-7762
Mailing Address - Street 1:2 MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-9402
Mailing Address - Country:US
Mailing Address - Phone:304-777-7762
Mailing Address - Fax:740-376-2566
Practice Address - Street 1:108 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3338
Practice Address - Country:US
Practice Address - Phone:304-777-7762
Practice Address - Fax:740-376-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty