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General NPI Number Information
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NPI Number | 1154692168
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Entity Type | Organization
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Legal Business Name | BACK IN MOTION CHIROPRACTIC & ACUPUNCTURE CLINIC, PLLC
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 2100 S COLUMBIA RD STE 114
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City | GRAND FORKS
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State | ND
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Zip | 58201-5895
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Country | US
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Telephone | 701-471-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 S COLUMBIA RD STE 114
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City | GRAND FORKS
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State | ND
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Zip | 58201-5895
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. ASHLEIGH ROSE BENTZ
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Credential | DC
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Telephone | 701-471-7084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 880
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License Number State | ND
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