Provider Demographics
NPI:1609113414
Name:BACK AND BODY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK AND BODY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WHIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-621-5080
Mailing Address - Street 1:500 W BROADWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0842
Mailing Address - Country:US
Mailing Address - Phone:712-621-5080
Mailing Address - Fax:
Practice Address - Street 1:500 W BROADWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0842
Practice Address - Country:US
Practice Address - Phone:712-621-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty