Organization
BACK TO WELLNESS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEATHER LYNN DIEDERICH DC (OWNER)
(802) 434-6669
Entity
Organization
Contact information
Practice address
368 DORSET ST STE 3, SOUTH BURLINGTON, VT 05403-6236
(802) 864-4959
(802) 864-4959
Mailing address
368 DORSET ST STE 3, SOUTH BURLINGTON, VT 05403-6236
(802) 864-4959
(802) 864-4959
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
006-0000998
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VN1626
—
VT
Enumeration date
07/29/2010
Last updated
09/21/2011
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