Healthcare Provider Details

I. General information

NPI: 1740045871
Provider Name (Legal Business Name): BACK IN MOTION GROUP CHIROPRACTIC, OT, RN, PT, SLP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 E 14TH ST STE 209
BROOKLYN NY
11235-3973
US

IV. Provider business mailing address

2625 E 14TH ST STE 209
BROOKLYN NY
11235-3973
US

V. Phone/Fax

Practice location:
  • Phone: 347-395-1717
  • Fax: 347-429-7721
Mailing address:
  • Phone: 347-395-1717
  • Fax: 347-429-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MIKHAYLOFF
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 917-957-0397