Provider Demographics
NPI:1356542914
Name:BACK IN ACTION CHIROPRACTIC
Entity type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOFIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANLONDERSELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-285-6333
Mailing Address - Street 1:12626 RIVERSIDE DR
Mailing Address - Street 2:SUITE #512
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3420
Mailing Address - Country:US
Mailing Address - Phone:818-285-6333
Mailing Address - Fax:818-285-6335
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:SUITE #512
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3420
Practice Address - Country:US
Practice Address - Phone:818-285-6333
Practice Address - Fax:818-285-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26939111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty