Provider Demographics
NPI:1609979269
Name:BACK IN ACTION CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC INC
Other - Org Name:DONALDSON CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:706-554-5055
Mailing Address - Street 1:PO BOX 1513
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830
Mailing Address - Country:US
Mailing Address - Phone:706-554-1040
Mailing Address - Fax:706-554-5055
Practice Address - Street 1:250 E 6TH STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830
Practice Address - Country:US
Practice Address - Phone:706-554-1040
Practice Address - Fax:706-554-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGBFMedicare PIN