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General NPI Number Information
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NPI Number | 1386138642
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Entity Type | Organization
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Legal Business Name | BACK IN MOTION P.A.
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 309 KINGSLEY LAKE DR STE 901
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3048
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Country | US
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Telephone | 904-514-4483
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Fax | 904-325-9049
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Provider Business Mailing Address
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Address Line | 225 HOPKINS ST APT A
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-4890
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Country | US
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Telephone | 904-514-4483
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. COLBY CALTRIDER
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Credential | DC
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Telephone | 904-514-4483
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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 | CH11232
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License Number State | FL
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