1033513791 NPI number — BACK IN MOTION CHIROPRACTIC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033513791 NPI number — BACK IN MOTION CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK IN MOTION CHIROPRACTIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033513791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1595 GRAND AVE
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59102-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-652-5140
Provider Business Mailing Address Fax Number:
406-294-2822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1643 24TH ST W STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59102-2677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-652-5140
Provider Business Practice Location Address Fax Number:
406-294-2822
Provider Enumeration Date:
10/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DEHERRERA
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
SEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-652-5140

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHI-CHI-LIC-3416 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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