Provider Demographics
NPI:1609690395
Name:BACK IN MOTION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK IN MOTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-227-2454
Mailing Address - Street 1:2122 VETERANS MEMORIAL PKWY S STE C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-9339
Mailing Address - Country:US
Mailing Address - Phone:765-227-2454
Mailing Address - Fax:
Practice Address - Street 1:2122 VETERANS MEMORIAL PKWY S STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-9339
Practice Address - Country:US
Practice Address - Phone:765-227-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty