Provider Demographics
NPI:1932224367
Name:BACKROADS CHIROPRACTIC PC
Entity type:Organization
Organization Name:BACKROADS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ELWER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-475-9103
Mailing Address - Street 1:716 W BROOKSIDE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2073
Mailing Address - Country:US
Mailing Address - Phone:719-475-9103
Mailing Address - Fax:719-475-2225
Practice Address - Street 1:716 W BROOKSIDE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2073
Practice Address - Country:US
Practice Address - Phone:719-475-9103
Practice Address - Fax:719-475-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807626Medicare PIN