Provider Demographics
NPI:1457559445
Name:BACK IN LINE FAMILY CHIROPRACTIC PSC INC
Entity type:Organization
Organization Name:BACK IN LINE FAMILY CHIROPRACTIC PSC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-824-6700
Mailing Address - Street 1:1212 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097-8503
Mailing Address - Country:US
Mailing Address - Phone:859-824-6700
Mailing Address - Fax:859-824-6720
Practice Address - Street 1:1212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-8503
Practice Address - Country:US
Practice Address - Phone:859-824-6700
Practice Address - Fax:859-824-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000221738OtherANTHEM BLUE CROSS BLUE SH
KYK4546OtherSTATE LICENSE
KY85002723Medicaid
KY85002723Medicaid