# BACK TO WELLNESS PLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912211210
- **Authorized official:** DR. HEATHER LYNN DIEDERICH DC (OWNER)
- **Authorized official phone:** (802) 434-6669

## Contact information

- **Practice address:** 368 DORSET ST STE 3, SOUTH BURLINGTON, VT 05403-6236
- **Practice address phone:** (802) 864-4959
- **Practice address fax:** (802) 864-4959
- **Mailing address:** 368 DORSET ST STE 3, SOUTH BURLINGTON, VT 05403-6236
- **Mailing address phone:** (802) 864-4959
- **Mailing address fax:** (802) 864-4959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 006-0000998 | VT | Yes |

## Other

- **Enumeration date:** 07/29/2010
- **Last updated:** 09/21/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | VN1626 | — | VT |