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General NPI Number Information
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NPI Number | 1578743225
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Entity Type | Organization
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Legal Business Name | BACK ON TRACK, INC
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Dates
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Enumeration Date | 11/10/2007
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 528 AVENUE F
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City | BOGALUSA
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State | LA
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Zip | 70427-3636
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Country | US
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Telephone | 985-735-1112
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Fax | 985-735-1386
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Provider Business Mailing Address
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Address Line | 528 AVENUE F
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City | BOGALUSA
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State | LA
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Zip | 70427-3636
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Country | US
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Telephone | 985-735-1112
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Fax | 985-735-1386
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID LEE KILLEN
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Credential | D.C.
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Telephone | 985-735-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1416
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD009648
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License Number State | LA
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