1649500596 NPI number — BACK2HEALTH - FRENCH LICK, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649500596 NPI number — BACK2HEALTH - FRENCH LICK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK2HEALTH - FRENCH LICK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649500596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
567 S MAPLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRENCH LICK
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47432-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-936-6050
Provider Business Mailing Address Fax Number:
812-936-6051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
567 S MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH LICK
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-936-6050
Provider Business Practice Location Address Fax Number:
812-936-6051
Provider Enumeration Date:
12/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SNIDER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-882-1241

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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