Provider Demographics
NPI:1144401621
Name:BACK IN LINE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK IN LINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:ARAGON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-293-1810
Mailing Address - Street 1:4007 N FLOWING WELLS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-2404
Mailing Address - Country:US
Mailing Address - Phone:520-293-1810
Mailing Address - Fax:
Practice Address - Street 1:4007 N FLOWING WELLS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-2404
Practice Address - Country:US
Practice Address - Phone:520-293-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75021Medicare PIN