Provider Demographics
NPI:1285165894
Name:BACK IN MOTION WITH CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BACK IN MOTION WITH CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:YARITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-634-4878
Mailing Address - Street 1:3589 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-5405
Mailing Address - Country:US
Mailing Address - Phone:208-634-4878
Mailing Address - Fax:208-634-4878
Practice Address - Street 1:337 DEINHARD LN
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4703
Practice Address - Country:US
Practice Address - Phone:208-634-4878
Practice Address - Fax:208-634-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty