Provider Demographics
NPI:1760752380
Name:BACK IN ACTION LLC
Entity Type:Organization
Organization Name:BACK IN ACTION LLC
Other - Org Name:MADISON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-273-4377
Mailing Address - Street 1:3641 CLIFTY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1649
Mailing Address - Country:US
Mailing Address - Phone:812-273-4377
Mailing Address - Fax:812-273-4377
Practice Address - Street 1:3641 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1649
Practice Address - Country:US
Practice Address - Phone:812-273-4377
Practice Address - Fax:812-273-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001312A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN194970Medicare UPIN