MEDICARE: NATURAL BALANCE ORTHOTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	016.002683	IL
2	332BC3200X	Customized Equipment (DME)
3	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1043678931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURAL BALANCE ORTHOTICS

Provider Business Mailing Address
First Line	:	1864 JOHNS DR
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-1657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1864 JOHNS DR
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-1657
Country	:	US
Telephone Number	:	847-729-7923
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON BERGMANN
Credential	:	CPED
Telephone Number	:	847-729-7923

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	02/06/2017

Similar Medicare Providers

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Practice Location Address:

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60025-1657

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1427607860 — EMILY SHANNON MURRAY OTR
Practice Location Address:

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Practice Location Address:

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