Provider Demographics
NPI:1346572328
Name:BACK IN LINE SYSTEMS, LLC
Entity Type:Organization
Organization Name:BACK IN LINE SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-505-5665
Mailing Address - Street 1:110 EVANS MILL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1643
Mailing Address - Country:US
Mailing Address - Phone:770-505-5665
Mailing Address - Fax:
Practice Address - Street 1:110 EVANS MILL DR STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1643
Practice Address - Country:US
Practice Address - Phone:770-505-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty