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General NPI Number Information
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NPI Number | 1215234448
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Entity Type | Organization
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Legal Business Name | BACK IN MOTION CHIROPRACTIC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 1817 WASHINGTON ST
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City | TWO RIVERS
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State | WI
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Zip | 54241-2625
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Country | US
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Telephone | 920-553-0328
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Fax | 920-553-0330
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Provider Business Mailing Address
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Address Line | 1817 WASHINGTON ST
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City | TWO RIVERS
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State | WI
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Zip | 54241-2625
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Country | US
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Telephone | 920-553-0328
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Fax | 920-553-0330
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICK KENNETH LAWSON JR.
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Credential | DC
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Telephone | 920-553-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 4648-012
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License Number State | WI
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