Provider Demographics
NPI:1972789824
Name:BACK AT HOME CHIROPRACTIC AND INJURY SERVICES, LLC
Entity type:Organization
Organization Name:BACK AT HOME CHIROPRACTIC AND INJURY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-428-9340
Mailing Address - Street 1:5591 MISSISSIPPI DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2464
Mailing Address - Country:US
Mailing Address - Phone:513-428-9340
Mailing Address - Fax:
Practice Address - Street 1:5591 MISSISSIPPI DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2464
Practice Address - Country:US
Practice Address - Phone:513-428-9340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty