Provider Demographics
NPI:1740045871
Name:BACK IN MOTION GROUP CHIROPRACTIC, OT, RN, PT, SLP PLLC
Entity type:Organization
Organization Name:BACK IN MOTION GROUP CHIROPRACTIC, OT, RN, PT, SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAYLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-957-0397
Mailing Address - Street 1:2251 KNAPP ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5726
Mailing Address - Country:US
Mailing Address - Phone:917-957-0397
Mailing Address - Fax:347-429-7721
Practice Address - Street 1:2001 AVENUE P, SUITE A2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1420
Practice Address - Country:US
Practice Address - Phone:917-957-0397
Practice Address - Fax:347-429-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty