Provider Demographics
NPI:1285903070
Name:BACK ACRES INC.
Entity type:Organization
Organization Name:BACK ACRES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-753-4871
Mailing Address - Street 1:4415 E. MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2356
Mailing Address - Country:US
Mailing Address - Phone:574-753-4871
Mailing Address - Fax:574-753-4871
Practice Address - Street 1:4415 E. MARKET STREET
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2356
Practice Address - Country:US
Practice Address - Phone:574-753-4871
Practice Address - Fax:574-753-4871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK ACRES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN482111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty