Provider Demographics
NPI:1053534685
Name:BACK AND NECK CENTER
Entity type:Organization
Organization Name:BACK AND NECK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-392-3131
Mailing Address - Street 1:1403 MILNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2580
Mailing Address - Country:US
Mailing Address - Phone:434-392-3131
Mailing Address - Fax:434-392-3133
Practice Address - Street 1:1403 MILNWOOD RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2580
Practice Address - Country:US
Practice Address - Phone:434-392-3131
Practice Address - Fax:434-392-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU55351Medicare UPIN
VAC04782Medicare ID - Type Unspecified