Provider Demographics
NPI:1417202631
Name:BACK IN ACTION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-232-9075
Mailing Address - Street 1:622 BURNETT AVE
Mailing Address - Street 2:PO BOX 1728
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6126
Mailing Address - Country:US
Mailing Address - Phone:515-232-9075
Mailing Address - Fax:515-232-4995
Practice Address - Street 1:622 BURNETT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6126
Practice Address - Country:US
Practice Address - Phone:515-232-9075
Practice Address - Fax:515-232-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007550261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center