Provider Demographics
NPI:1649610676
Name:BACKS AND US, LLC
Entity type:Organization
Organization Name:BACKS AND US, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-629-2121
Mailing Address - Street 1:362 BOARDMAN POLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4934
Mailing Address - Country:US
Mailing Address - Phone:330-629-2121
Mailing Address - Fax:330-629-2323
Practice Address - Street 1:362 BOARDMAN POLAND RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4934
Practice Address - Country:US
Practice Address - Phone:330-629-2121
Practice Address - Fax:330-629-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2664040Medicaid
OH2664040Medicaid