Provider Demographics
NPI:1245561265
Name:THE BACK CARE SHOP, INC. DBA BIOWORKS
Entity Type:Organization
Organization Name:THE BACK CARE SHOP, INC. DBA BIOWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-793-7335
Mailing Address - Street 1:7791 COOPER RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7734
Mailing Address - Country:US
Mailing Address - Phone:513-793-7335
Mailing Address - Fax:513-985-3865
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-874-1939
Practice Address - Fax:513-874-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9025425100Medicaid
OH0575408Medicaid
0131270001Medicare NSC