Provider Demographics
NPI:1891940466
Name:BACK FOR MORE, LLC
Entity Type:Organization
Organization Name:BACK FOR MORE, LLC
Other - Org Name:RELAX THE BACK #248
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-737-2225
Mailing Address - Street 1:717 E EL CAMINO REAL
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2975
Mailing Address - Country:US
Mailing Address - Phone:408-737-2225
Mailing Address - Fax:408-737-2815
Practice Address - Street 1:717 E EL CAMINO REAL
Practice Address - Street 2:SUITE 10
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2975
Practice Address - Country:US
Practice Address - Phone:408-737-2225
Practice Address - Fax:408-737-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGH100991211332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies