Provider Demographics
NPI:1760700652
Name:BACK IN LINE CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:BACK IN LINE CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:267-374-8788
Mailing Address - Street 1:684 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MOHRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19541-9256
Mailing Address - Country:US
Mailing Address - Phone:267-374-8788
Mailing Address - Fax:
Practice Address - Street 1:1642 ROUTE 309
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1805
Practice Address - Country:US
Practice Address - Phone:267-374-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty