Provider Demographics
NPI:1184828618
Name:BACK IN MOTION CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BACK IN MOTION CHIROPRACTIC P.C.
Other - Org Name:BACK IN MOTION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-357-7585
Mailing Address - Street 1:1115 BLACK LAKE BLVD SW STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1026
Mailing Address - Country:US
Mailing Address - Phone:360-357-7585
Mailing Address - Fax:360-236-0649
Practice Address - Street 1:1115 BLACK LAKE BLVD SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1026
Practice Address - Country:US
Practice Address - Phone:360-357-7585
Practice Address - Fax:360-236-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA125645OtherGROUP L&I
WACH00003654OtherSTATE LICENCE
WA125644OtherINDAVIDUAL L&I
WA125644OtherINDAVIDUAL L&I
WACH00003654OtherSTATE LICENCE
U74501Medicare UPIN