| Organization Name: | THE BACK STOP LLC |
| NPI Number: | 1033521430 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK A KIMBLE (CHIROPRACTOR/OWNER) |
| Mailing Address: | 373 S Yukon Pkwy Ste C Yukon |
| State: | OK US |
| Postal Code: | 730994597 |
| Phone Number: | 4052653920 |
| Fax Number: | 4052653922 |
| NPI Enumeration Date: | 05/20/2014 |
| NPI Last Update Date: | 05/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 4154 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |