Provider Demographics
NPI:1386138642
Name:BACK IN MOTION P.A.
Entity type:Organization
Organization Name:BACK IN MOTION P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALTRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-514-4483
Mailing Address - Street 1:225 HOPKINS ST APT A
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-4890
Mailing Address - Country:US
Mailing Address - Phone:904-514-4483
Mailing Address - Fax:
Practice Address - Street 1:309 KINGSLEY LAKE DR STE 901
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3048
Practice Address - Country:US
Practice Address - Phone:904-514-4483
Practice Address - Fax:904-325-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty