Provider Demographics
NPI:1134242993
Name:BACK IN MOTION, PA
Entity type:Organization
Organization Name:BACK IN MOTION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-497-2996
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-0157
Mailing Address - Country:US
Mailing Address - Phone:207-497-2996
Mailing Address - Fax:207-497-3467
Practice Address - Street 1:66 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILBRIDGE
Practice Address - State:ME
Practice Address - Zip Code:04658
Practice Address - Country:US
Practice Address - Phone:207-497-2996
Practice Address - Fax:207-497-3467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME55820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMN4133OtherHARVARD PILGRIM
ME2467127OtherAETNA
ME210390000Medicaid
MEM183695OtherCIGNA
ME098672OtherBCBS
ME2485306OtherAETNA
ME350052171OtherRAILROAD MEDICARE
ME210390000Medicaid
MEMM8615Medicare PIN