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General NPI Number Information
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NPI Number | 1649610676
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Entity Type | Organization
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Legal Business Name | BACKS AND US, LLC
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 362 BOARDMAN POLAND RD
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City | BOARDMAN
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State | OH
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Zip | 44512-4934
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Country | US
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Telephone | 330-629-2121
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Fax | 330-629-2323
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Provider Business Mailing Address
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Address Line | 362 BOARDMAN POLAND RD
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City | BOARDMAN
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State | OH
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Zip | 44512-4934
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Country | US
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Telephone | 330-629-2121
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Fax | 330-629-2323
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE M SHAW
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Credential | D.C.
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Telephone | 330-629-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3675
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License Number State | OH
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