| Organization Name: | BACKROAD HEALTH CARE |
| NPI Number: | 1467857086 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAUL HAVRILKA (OWNER/PROVIDER) |
| Mailing Address: | 7825a East Grant Road Walnut Hill |
| State: | IL US |
| Postal Code: | 62893 |
| Phone Number: | 6185450707 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2014 |
| NPI Last Update Date: | 10/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209010715 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |