Healthcare Provider Details

I. General information

NPI: 1386729838
Provider Name (Legal Business Name): BACK IN MOTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GRAFTON STATION LN SITE G
YORKTOWN VA
23692-4776
US

IV. Provider business mailing address

121 GRAFTON STATION LN SITE G
YORKTOWN VA
23692-4776
US

V. Phone/Fax

Practice location:
  • Phone: 757-989-5393
  • Fax: 757-989-0551
Mailing address:
  • Phone: 757-989-5393
  • Fax: 757-989-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number0104001389
License Number StateVA

VIII. Authorized Official

Name: DR. CHRISTOPHER T CONNOLLY
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 757-810-5624