Provider Demographics
NPI:1588284277
Name:BACK IN MOTION DURABLE MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:BACK IN MOTION DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:NICK
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:937-439-9330
Mailing Address - Street 1:925 CONGRESS PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4098
Mailing Address - Country:US
Mailing Address - Phone:937-439-9330
Mailing Address - Fax:937-439-9337
Practice Address - Street 1:925 CONGRESS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4098
Practice Address - Country:US
Practice Address - Phone:937-439-9330
Practice Address - Fax:937-439-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies