Provider Demographics
NPI:1043684350
Name:PRIME BACK CHIROPRACTIC INC
Entity type:Organization
Organization Name:PRIME BACK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUKHRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-753-9600
Mailing Address - Street 1:3501 SHEPHERD LN
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-2325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3501 SHEPHERD LN
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-2325
Practice Address - Country:US
Practice Address - Phone:972-362-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty