Healthcare Provider Details

I. General information

NPI: 1306065958
Provider Name (Legal Business Name): ERIK JAMES LINDHOLM CPO, LPO, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 BLACK RD
JOLIET IL
60435-3962
US

IV. Provider business mailing address

1316 BLACK RD
JOLIET IL
60435-3962
US

V. Phone/Fax

Practice location:
  • Phone: 815-531-5386
  • Fax:
Mailing address:
  • Phone: 815-531-5386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number213000217
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number211000293
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096-002049
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: