MEDICARE: BACK IN MOTION CHIROPRACTIC,DC,PLLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301008359	MI

General Provider Information

NPI Number	:	1689040800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN MOTION CHIROPRACTIC,DC,PLLC.

Provider Business Mailing Address
First Line	:	5452 SCHAEFER RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3223
Country	:	US
Telephone Number	:	313-586-3100
Fax Number	:	313-914-5368

Provider Business Practice Location Address
First Line	:	5452 SCHAEFER RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3223
Country	:	US
Telephone Number	:	313-586-3100
Fax Number	:	313-914-5368

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HASSAN REICHOUNI
Credential	:	DC
Telephone Number	:	313-586-3100

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	10/06/2015

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