Provider Demographics
NPI:1407910805
Name:BACK IN MOTION CHIRO & REHAB CTR LLC
Entity Type:Organization
Organization Name:BACK IN MOTION CHIRO & REHAB CTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-859-0166
Mailing Address - Street 1:PO BOX 750668
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-0668
Mailing Address - Country:US
Mailing Address - Phone:937-859-0166
Mailing Address - Fax:937-859-0401
Practice Address - Street 1:718 N HEINCKE RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-2742
Practice Address - Country:US
Practice Address - Phone:937-859-0166
Practice Address - Fax:937-859-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9353391Medicare PIN