Provider Demographics
NPI:1497995732
Name:BACK TO MOTION CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:BACK TO MOTION CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-376-0261
Mailing Address - Street 1:101 BEACON DR
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2016
Mailing Address - Country:US
Mailing Address - Phone:516-376-0261
Mailing Address - Fax:631-849-3887
Practice Address - Street 1:49 E MAIN ST
Practice Address - Street 2:UNIT #2
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2437
Practice Address - Country:US
Practice Address - Phone:516-376-0261
Practice Address - Fax:631-849-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009188-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000936OtherPTAN