Provider Demographics
NPI:1528211034
Name:BACK IN HEALTH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:BACK IN HEALTH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNNIS
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:COCKRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-665-7158
Mailing Address - Street 1:1801 LINCOLN WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2547
Mailing Address - Country:US
Mailing Address - Phone:208-665-7158
Mailing Address - Fax:208-664-2225
Practice Address - Street 1:1801 LINCOLN WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2547
Practice Address - Country:US
Practice Address - Phone:208-665-7158
Practice Address - Fax:208-664-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1174694384Medicare UPIN