Provider Demographics
NPI:1144527946
Name:BACK ON TRACK CHIROPRACTIC
Entity type:Organization
Organization Name:BACK ON TRACK CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-447-6618
Mailing Address - Street 1:3934 DIXIE HWY STE 510
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4179
Mailing Address - Country:US
Mailing Address - Phone:502-447-6618
Mailing Address - Fax:502-447-6419
Practice Address - Street 1:3934 DIXIE HWY STE 510
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4179
Practice Address - Country:US
Practice Address - Phone:502-447-6618
Practice Address - Fax:502-447-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty