Provider Demographics
NPI:1164756250
Name:BACK IN MOTION CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BACK IN MOTION CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAVAYERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-581-7246
Mailing Address - Street 1:24 HAMILTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4226
Mailing Address - Country:US
Mailing Address - Phone:518-581-7246
Mailing Address - Fax:518-581-4067
Practice Address - Street 1:24 HAMILTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4226
Practice Address - Country:US
Practice Address - Phone:518-581-7246
Practice Address - Fax:518-581-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty