Back to Wellness PLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

006-0000998 Issued in VT

Legal business name

BACK TO WELLNESS PLC

Practice address

368 Dorset St Ste 3
South Burlington, VT 05403-6236

Phone

(802) 864-4959

Fax

(802) 864-4959

NPI assigned

Jul 29, 2010

Last updated

Sep 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Heather Lynn Diederich, DCNPI 1326101080

Title

Owner

Phone

(802) 434-6669

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Locations

Practitioners 1

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.

• Heather Lynn Diederich, D.C.

  • Chiropractor
  • South Burlington, VT
  • NPI 1326101080
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316563200000",
    "number": "1912211210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 DORSET ST STE 3",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036236",
            "telephone_number": "802-864-4959",
            "fax_number": "802-864-4959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "368 DORSET ST STE 3",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036236",
            "telephone_number": "802-864-4959",
            "fax_number": "802-864-4959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO WELLNESS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "last_updated": "2011-09-21",
        "status": "A",
        "authorized_official_last_name": "DIEDERICH",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-434-6669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VT",
            "license": "006-0000998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "VN1626",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Beth Axelrod, LICSW
• Nonna Sophia Aydinyan-Allaire, PT, DPT
• Ayla O'Mara, Ma, LLC
• Stephen Baad, M.D.
• Back and Neck Center (Hemmett Health)
• Brittany Baker, MS, RD, CD
• Erin Baker, MS
• James Baker, DMD
• Stacia Hillary Baker, MSW, LCSW
• Nancy Barber

• Clinic/Center in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Clinic/Center in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.