Healthcare Provider Details

I. General information

NPI: 1629558812
Provider Name (Legal Business Name): BACK IN MOTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 GEORGETOWN RD. NW
CLEVELAND TN
37312
US

IV. Provider business mailing address

3771 GEORGETOWN RD. NW
CLEVELAND TN
37312
US

V. Phone/Fax

Practice location:
  • Phone: 423-790-1425
  • Fax: 423-790-1426
Mailing address:
  • Phone: 423-790-1425
  • Fax: 423-790-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID TOY RAHAMAT
Title or Position: PRESIDENT
Credential: DC
Phone: 423-790-1425