| Back To Wellness Plc | |
|
368 Dorset St Ste 3 South Burlington VT 05403-6236 | |
| (802) 864-4959 | |
| (802) 864-4959 |
| Full Name | Back To Wellness Plc |
|---|---|
| Speciality | Clinic/Center |
| Location | 368 Dorset St Ste 3, South Burlington, Vermont |
| Authorized Official Name and Position | Heather Lynn Diederich (OWNER) |
| Authorized Official Contact | 8024346669 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Back To Wellness Plc 368 Dorset St Ste 3 South Burlington VT 05403-6236 Ph: (802) 864-4959 | Back To Wellness Plc 368 Dorset St Ste 3 South Burlington VT 05403-6236 Ph: (802) 864-4959 |
| NPI Number | 1912211210 |
|---|---|
| Provider Enumeration Date | 07/29/2010 |
| Last Update Date | 09/21/2011 |
| Medicare PECOS PAC ID | 4981876349 |
|---|---|
| Medicare Enrollment ID | O20111006000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912211210 | NPI | - | NPPES |
| VN1626 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 006-0000998 (Vermont) | Primary |
| Provider Name | Heather L Diederich |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1326101080 PECOS PAC ID: 3870765233 Enrollment ID: I20111006000293 |
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