Provider Demographics
NPI:1770903684
Name:BACK IN ACTION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-554-8827
Mailing Address - Street 1:3935 N 75 W
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-4111
Mailing Address - Country:US
Mailing Address - Phone:435-554-8827
Mailing Address - Fax:435-569-0293
Practice Address - Street 1:3935 N 75 W
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4111
Practice Address - Country:US
Practice Address - Phone:435-554-8827
Practice Address - Fax:435-569-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1544111NS0005X
UT8367563-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty