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General NPI Number Information
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NPI Number | 1912052259
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Entity Type | Organization
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Legal Business Name | BACK IN MOTION CHIROPRACTIC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2200 BUECHEL AVE STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40218-2664
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Country | US
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Telephone | 502-491-0305
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Fax | 502-499-0450
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Provider Business Mailing Address
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Address Line | 2200 BUECHEL AVE SUITE 101
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City | LOUISVILLE
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State | KY
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Zip | 40218-2664
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Country | US
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Telephone | 502-491-0305
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Fax | 502-499-0450
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROL L SELLS
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Credential | DC
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Telephone | 502-491-0305
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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 | KY
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