Healthcare Provider Details

I. General information

NPI: 1801109301
Provider Name (Legal Business Name): JOHN T BRINKMANN CPO, LPO, FAAOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ROXBURY RD
ROCKFORD IL
61107-5090
US

IV. Provider business mailing address

324 ROXBURY RD
ROCKFORD IL
61107-5090
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-9491
  • Fax: 815-381-7498
Mailing address:
  • Phone: 815-398-9491
  • Fax: 815-381-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number213000031
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number211000028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: