Provider Demographics
NPI:1003469529
Name:BACK ON TRACK CHIROPRACTIC & ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:BACK ON TRACK CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALLAN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-919-4949
Mailing Address - Street 1:PO BOX 26202
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-6202
Mailing Address - Country:US
Mailing Address - Phone:641-919-4949
Mailing Address - Fax:
Practice Address - Street 1:9904 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1756
Practice Address - Country:US
Practice Address - Phone:913-276-0508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty