Healthcare Provider Details

I. General information

NPI: 1033513791
Provider Name (Legal Business Name): BACK IN MOTION CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 24TH ST W STE 203
BILLINGS MT
59102-2677
US

IV. Provider business mailing address

1595 GRAND AVE 200
BILLINGS MT
59102-3004
US

V. Phone/Fax

Practice location:
  • Phone: 406-652-5140
  • Fax: 406-294-2822
Mailing address:
  • Phone: 406-652-5140
  • Fax: 406-294-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHI-CHI-LIC-3416
License Number StateMT

VIII. Authorized Official

Name: DR. JEREMY SEAN DEHERRERA
Title or Position: OWNER
Credential: D.C.
Phone: 406-652-5140