Provider Demographics
NPI:1891973228
Name:BACK BENDERS INC.
Entity Type:Organization
Organization Name:BACK BENDERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIFLET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-877-2666
Mailing Address - Street 1:10515 N ORACLE RD. #167
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9390
Mailing Address - Country:US
Mailing Address - Phone:520-877-2666
Mailing Address - Fax:520-877-9183
Practice Address - Street 1:10515 N ORACLE RD STE 167
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85737-9390
Practice Address - Country:US
Practice Address - Phone:520-877-2666
Practice Address - Fax:520-877-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7031261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ121533Medicare PIN
AZU85249Medicare UPIN