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General NPI Number Information
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NPI Number | 1255792180
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Entity Type | Organization
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Legal Business Name | KELTIC LIMB AND BRACE, INC.
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Dates
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Enumeration Date | 03/20/2016
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Last Update Date | 03/20/2016
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Provider Practice Location Address
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Address Line | 1316 BLACK RD
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City | JOLIET
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State | IL
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Zip | 60435-3962
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Country | US
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Telephone | 661-422-7223
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Fax | 661-422-3772
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Provider Business Mailing Address
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Address Line | 1316 BLACK RD
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City | JOLIET
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State | IL
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Zip | 60435-3962
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Country | US
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Telephone | 661-422-7223
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Fax | 661-422-3772
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERIK J LINDHOLM
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Credential | CPO, LPO, ATC
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Telephone | 661-422-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 211000293
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License Number State | IL
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