NPIMap

Organization Active NPI

Back to Life LLC

  • Chiropractor
  • Hancock, NH
National Provider Identifier
1093038010
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
8450809 Issued in NH
Legal business name
BACK TO LIFE LLC
Practice address
3 Elmwood Rd
Hancock, NH 03449-5629
Phone
(603) 525-3335
Fax
(866) 611-5548
NPI assigned
Mar 4, 2010
Last updated
Jan 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stephanie J Clark, DCNPI 1851395453
Title
President
Phone
(603) 525-3335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 8450809 NH Primary

Addresses

Primary practice location

3 Elmwood Rd
Hancock, NH 03449-5629

Mailing address

3 Elmwood Rd
Hancock, NH 03449-5629
Phone (603) 525-3335

Other identifiers 2

IdentifierTypeStateIssuer
08132071OtherNHBCBS
0019271OtherNHMEDICARE PTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578614400000",
    "number": "1093038010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ELMWOOD RD",
            "city": "HANCOCK",
            "state": "NH",
            "postal_code": "034495629",
            "telephone_number": "603-525-3335",
            "fax_number": "866-661-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ELMWOOD RD",
            "city": "HANCOCK",
            "state": "NH",
            "postal_code": "034495629",
            "telephone_number": "603-525-3335",
            "fax_number": "866-611-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-04",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "603-525-3335",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NH",
            "license": "8450809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08132071",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0019271",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hancock, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.