Provider Demographics
NPI:1508090556
Name:BACK IN ACTION CHIROPRACTORS CO. INC
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTORS CO. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMP
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:386-439-9099
Mailing Address - Street 1:99 OLD KINGS RD S
Mailing Address - Street 2:UNIT #2
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-4317
Mailing Address - Country:US
Mailing Address - Phone:386-439-9099
Mailing Address - Fax:386-439-9091
Practice Address - Street 1:99 OLD KINGS RD S
Practice Address - Street 2:UNIT #2
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-4317
Practice Address - Country:US
Practice Address - Phone:386-439-9099
Practice Address - Fax:386-439-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty