Provider Demographics
NPI:1679083588
Name:BACK IN ACTION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYREL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-223-0199
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-0729
Mailing Address - Country:US
Mailing Address - Phone:660-223-0199
Mailing Address - Fax:660-438-6943
Practice Address - Street 1:204 W SEMINARY ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355
Practice Address - Country:US
Practice Address - Phone:660-223-0199
Practice Address - Fax:660-438-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015044724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty