1447480231 NPI number — BACK IN LINE 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 1447480231 NPI number — BACK IN LINE CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK IN LINE 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:
1447480231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 RIDGE ST
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
TONGANOXIE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66086-9304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-845-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 RIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
TONGANOXIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66086-9304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-845-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DELANEY
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-845-9000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01-05269 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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