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General NPI Number Information
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NPI Number | 1184828618
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Entity Type | Organization
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Legal Business Name | BACK IN MOTION CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1115 BLACK LAKE BLVD SW STE A
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City | OLYMPIA
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State | WA
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Zip | 98502-1026
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Country | US
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Telephone | 360-357-7585
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Fax | 360-236-0649
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Provider Business Mailing Address
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Address Line | 1115 BLACK LAKE BLVD SW STE A
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City | OLYMPIA
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State | WA
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Zip | 98502-1026
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Country | US
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Telephone | 360-357-7585
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Fax | 360-236-0649
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD MICHAEL SORAN
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Credential | D.C.
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Telephone | 360-357-7585
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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 | CH00003654
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License Number State | WA
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