Provider Demographics
NPI:1033513791
Name:BACK IN MOTION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BACK IN MOTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:DEHERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-652-5140
Mailing Address - Street 1:1595 GRAND AVE
Mailing Address - Street 2:200
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3004
Mailing Address - Country:US
Mailing Address - Phone:406-652-5140
Mailing Address - Fax:406-294-2822
Practice Address - Street 1:1643 24TH ST W STE 203
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2677
Practice Address - Country:US
Practice Address - Phone:406-652-5140
Practice Address - Fax:406-294-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-3416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty