Provider Demographics
NPI:1497934301
Name:BACK IN ACTION HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:BACK IN ACTION HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:770-639-1082
Mailing Address - Street 1:2201 SANDRIDGE PL SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8447
Mailing Address - Country:US
Mailing Address - Phone:770-639-1082
Mailing Address - Fax:404-629-2943
Practice Address - Street 1:2201 SANDRIDGE PL SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8447
Practice Address - Country:US
Practice Address - Phone:770-639-1082
Practice Address - Fax:404-629-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty