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General NPI Number Information
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NPI Number | 1457176513
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Entity Type | Organization
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Legal Business Name | BACK IN ACTION SPINE AND SPORT LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 230 S 68TH ST STE 1206
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City | WEST DES MOINES
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State | IA
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Zip | 50266-8176
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Country | US
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Telephone | 515-494-6554
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Fax |
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Provider Business Mailing Address
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Address Line | 230 S 68TH ST STE 1206
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City | WEST DES MOINES
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State | IA
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Zip | 50266-8176
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Country | US
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Telephone | 515-494-6554
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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 | JACOB CAMPBELL
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Credential | DC
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Telephone | 515-210-0323
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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 |
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License Number State |
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