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General NPI Number Information
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NPI Number | 1417202631
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Entity Type | Organization
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Legal Business Name | BACK IN ACTION CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/14/2012
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Last Update Date | 07/14/2012
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Provider Practice Location Address
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Address Line | 622 BURNETT AVE
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City | AMES
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State | IA
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Zip | 50010-6126
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Country | US
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Telephone | 515-232-9075
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Fax | 515-232-4995
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Provider Business Mailing Address
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Address Line | 622 BURNETT AVE PO BOX 1728
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City | AMES
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State | IA
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Zip | 50010-6126
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Country | US
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Telephone | 515-232-9075
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Fax | 515-232-4995
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN HEUN
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Credential | D.C.
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Telephone | 515-232-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 007550
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License Number State | IA
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