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General NPI Number Information
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NPI Number | 1003632084
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Entity Type | Organization
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Legal Business Name | DJO, LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2373 CEDAR PARK DR STE 100
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City | HOLT
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State | MI
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Zip | 48842-3102
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Country | US
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Telephone | 517-908-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 LAKE VISTA DR STE 200
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City | LEWISVILLE
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State | TX
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Zip | 75067-3889
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Country | US
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Telephone | 704-749-6291
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Fax | 704-831-8300
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANDRES MORENO III
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Credential |
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Telephone | 800-321-9549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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