Provider Demographics
NPI:1689889461
Name:BACK TO WELLNESS CHIROPRACTIC INC
Entity type:Organization
Organization Name:BACK TO WELLNESS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-685-7577
Mailing Address - Street 1:409 W BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7401
Mailing Address - Country:US
Mailing Address - Phone:813-685-7577
Mailing Address - Fax:813-684-9145
Practice Address - Street 1:409 W BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7401
Practice Address - Country:US
Practice Address - Phone:813-685-7577
Practice Address - Fax:813-684-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU72730Medicare UPIN
FL55781Medicare ID - Type Unspecified