| Back In Line Systems, Llc | |
|
110 Evans Mill Dr Ste 105, Dallas, GA 30157-1643 | |
| (770) 505-5665 | |
| Not Available |
| Full Name | Back In Line Systems, Llc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 110 Evans Mill Dr Ste 105, Dallas, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346572328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | CHIRO08541 (Georgia) | Primary |
| Provider Name | Kimdi J Fair |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1316376890 PECOS PAC ID: 0749274629 Enrollment ID: I20040413001069 |
| Provider Name | Ladonna C Bense |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1831321272 PECOS PAC ID: 4587953575 Enrollment ID: I20160517000059 |
| Mailing Address | Practice Location Address |
|---|---|
| Back In Line Systems, Llc 110 Evans Mill Dr Ste 105, Dallas, GA 30157-1643 Ph: (770) 505-5665 | Back In Line Systems, Llc 110 Evans Mill Dr Ste 105, Dallas, GA 30157-1643 Ph: (770) 505-5665 |
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