Provider Demographics
NPI:1134310766
Name:BACK IN MOTION CHIROPRACTIC & REHAB, LLC
Entity Type:Organization
Organization Name:BACK IN MOTION CHIROPRACTIC & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUSKARICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-725-8200
Mailing Address - Street 1:1239 MOUNT VERNON AVE # B
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5624
Mailing Address - Country:US
Mailing Address - Phone:740-725-8200
Mailing Address - Fax:740-725-9020
Practice Address - Street 1:1239 MOUNT VERNON AVE # B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5624
Practice Address - Country:US
Practice Address - Phone:740-725-8200
Practice Address - Fax:740-725-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9352721Medicare PIN