Provider Demographics
NPI:1043415821
Name:SHES BACK LLC
Entity type:Organization
Organization Name:SHES BACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-377-2919
Mailing Address - Street 1:3307 S COLLEGE AVE UNIT 107
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4196
Mailing Address - Country:US
Mailing Address - Phone:970-377-2919
Mailing Address - Fax:
Practice Address - Street 1:3307 S COLLEGE AVE UNIT 107
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4196
Practice Address - Country:US
Practice Address - Phone:970-377-2919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841186223Medicare UPIN
CO001329486Medicare UPIN
CO7534024Medicare UPIN