Provider Demographics
NPI:1346571338
Name:BACK IN MOTION CLINIC OF CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK IN MOTION CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GOLDIZEN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:864-601-9012
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-1058
Mailing Address - Country:US
Mailing Address - Phone:864-601-9012
Mailing Address - Fax:
Practice Address - Street 1:703 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-1541
Practice Address - Country:US
Practice Address - Phone:864-601-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3498261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service