Organization
BACK TO LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE J CLARK DC (PRESIDENT)
(603) 525-3335
Entity
Organization
Contact information
Practice address
3 ELMWOOD RD, HANCOCK, NH 03449-5629
(603) 525-3335
(866) 611-5548
Mailing address
3 ELMWOOD RD, HANCOCK, NH 03449-5629
(603) 525-3335
(866) 661-5548
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8450809
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019271
MEDICARE PTAN
NH
01
—
08132071
BCBS
NH
Enumeration date
03/04/2010
Last updated
01/10/2020
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