Healthcare Provider Details

I. General information

NPI: 1912052259
Provider Name (Legal Business Name): BACK IN MOTION CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BUECHEL AVE STE 101
LOUISVILLE KY
40218-2664
US

IV. Provider business mailing address

2200 BUECHEL AVE SUITE 101
LOUISVILLE KY
40218-2664
US

V. Phone/Fax

Practice location:
  • Phone: 502-491-0305
  • Fax: 502-499-0450
Mailing address:
  • Phone: 502-491-0305
  • Fax: 502-499-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. CAROL L SELLS
Title or Position: OWNER
Credential: DC
Phone: 502-491-0305