Back on Track Chiropractic, LLC
Organization Active NPI Chiropractor · Labadie, MO
NPI 1104080688 · NPPES record last updated Jul 15, 2008
Key facts
- NPI
- 1104080688
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2008010491 (MO)
- Legal business name
- BACK ON TRACK CHIROPRACTIC, LLC
- Practice address
- 108 Front Street
Suite101
Labadie, MO 63055-1301 - Phone
- (636) 742-3733
- NPI assigned
- Jul 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Ashley Lane, D.C.
- Title
- Owner
- Phone
- (636) 742-3733
Practitioners 5
-
Abby Rose Painter, D.C.
-
Ashley M Fuller, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080813000740 | MO | Part B Supplier - Clinic/Group Practice | 6406921246 |
Receives reassigned benefits from 3 practitioners Practice locations: Labadie, MO |
National Provider Directory
Locations
108 Front St
Ste 101
Labadie, MO 63055
Phone (636) 742-3733
117 Front St
Labadie, MO 63055
Phone (636) 742-3733
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2008010491 | MO | Yes |
Addresses
Primary practice location
108 Front Street
Suite101
Labadie, MO 63055-1301
Mailing address
108 Front Street
Suite101
Labadie, MO 63055-1301
Phone (636) 742-3733
Other providers in Labadie, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.