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General NPI Number Information
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NPI Number | 1609690395
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Entity Type | Organization
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Legal Business Name | BACK IN MOTION CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 2122 VETERANS MEMORIAL PKWY S STE C
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City | LAFAYETTE
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State | IN
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Zip | 47909-9339
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Country | US
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Telephone | 765-227-2454
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 VETERANS MEMORIAL PKWY S STE C
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City | LAFAYETTE
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State | IN
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Zip | 47909-9339
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Country | US
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Telephone | 765-227-2454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BROOKE L BOYER
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Credential |
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Telephone | 765-227-2454
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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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