Provider Demographics
NPI:1689040800
Name:BACK IN MOTION CHIROPRACTIC,DC,PLLC.
Entity Type:Organization
Organization Name:BACK IN MOTION CHIROPRACTIC,DC,PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-586-3100
Mailing Address - Street 1:5452 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3223
Mailing Address - Country:US
Mailing Address - Phone:313-586-3100
Mailing Address - Fax:313-914-5368
Practice Address - Street 1:5452 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3223
Practice Address - Country:US
Practice Address - Phone:313-586-3100
Practice Address - Fax:313-914-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty