Provider Demographics
NPI:1801430152
Name:BACK IN ACTION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYREL
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-620-0276
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-0729
Mailing Address - Country:US
Mailing Address - Phone:660-620-0276
Mailing Address - Fax:660-438-6943
Practice Address - Street 1:2420 S LIMIT AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-6910
Practice Address - Country:US
Practice Address - Phone:660-620-0276
Practice Address - Fax:660-438-6943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK IN ACTION CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-30
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty