Provider Demographics
NPI:1720153299
Name:BACKBONE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BACKBONE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-316-1277
Mailing Address - Street 1:802 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1308
Mailing Address - Country:US
Mailing Address - Phone:517-316-1277
Mailing Address - Fax:517-316-2102
Practice Address - Street 1:802 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1308
Practice Address - Country:US
Practice Address - Phone:517-316-1277
Practice Address - Fax:517-316-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKB008544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043397003Medicaid
MI1720153299Medicaid
MI1043397003Medicaid