MEDICARE: BACK IN ACTION CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1801430152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN ACTION CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 729
Second Line	:
City	:	WARSAW
State	:	MO
Zip	:	65355-0729
Country	:	US
Telephone Number	:	660-620-0276
Fax Number	:	660-438-6943

Provider Business Practice Location Address
First Line	:	2420 S LIMIT AVE
Second Line	:
City	:	SEDALIA
State	:	MO
Zip	:	65301-6910
Country	:	US
Telephone Number	:	660-620-0276
Fax Number	:	660-438-6943

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TYREL REICHERT
Credential	:	DC
Telephone Number	:	660-620-0276

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	10/20/2020

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