Provider Demographics
NPI:1568596286
Name:BACK AND BODY CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:BACK AND BODY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONTGOMERY-TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-787-2800
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-0340
Mailing Address - Country:US
Mailing Address - Phone:606-787-2800
Mailing Address - Fax:606-787-2880
Practice Address - Street 1:69 HUSTONVILLE STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539
Practice Address - Country:US
Practice Address - Phone:606-787-2800
Practice Address - Fax:606-787-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY4614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6681Medicare PIN