Provider Demographics
NPI:1215234448
Name:BACK IN MOTION CHIROPRACTIC
Entity type:Organization
Organization Name:BACK IN MOTION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:920-553-0328
Mailing Address - Street 1:1817 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-2625
Mailing Address - Country:US
Mailing Address - Phone:920-553-0328
Mailing Address - Fax:920-553-0330
Practice Address - Street 1:1817 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-2625
Practice Address - Country:US
Practice Address - Phone:920-553-0328
Practice Address - Fax:920-553-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4648-012111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty