Organization Name: | BACK-IN-ACTION CHIROPRACTIC |
NPI Number: | 1235327180 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANDREW GARY BAKKEN (OWNER) |
Mailing Address: | 1524 S Green Bay Rd Suite 103 Mount Pleasant |
State: | WI US |
Postal Code: | 534065788 |
Phone Number: | 2628847580 |
Fax Number: | 2628847589 |
NPI Enumeration Date: | 10/04/2007 |
NPI Last Update Date: | 09/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 3804 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |