Provider Demographics
NPI:1285826990
Name:BACK IN LINE BACK CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:BACK IN LINE BACK CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:MARCIANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, C C EP
Authorized Official - Phone:954-584-2225
Mailing Address - Street 1:6991 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2907
Mailing Address - Country:US
Mailing Address - Phone:954-584-2225
Mailing Address - Fax:
Practice Address - Street 1:6991 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2907
Practice Address - Country:US
Practice Address - Phone:954-584-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU90756Medicare UPIN
FLK3631Medicare PIN