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General NPI Number Information
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NPI Number | 1104007137
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Entity Type | Organization
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Legal Business Name | KINETIC ORTHOTICS, INC.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3958 ROSE AVE
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1032
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Country | US
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Telephone | 708-246-9249
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Fax | 708-246-9249
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Provider Business Mailing Address
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Address Line | 3958 ROSE AVE
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1032
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Country | US
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Telephone | 708-246-9249
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Fax | 708-246-9249
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH SKERTICH
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Credential |
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Telephone | 708-246-9249
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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 | IL
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