MEDICARE: BOUNCE BACK 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	:	1942834270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNCE BACK CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2432 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	484-684-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	2432 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	484-684-1445
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC
Name	:	KIMBERLY DAVIS
Credential	:
Telephone Number	:	484-684-1445

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	02/11/2026

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