MEDICARE: KINETIC ORTHOTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)		IL

General Provider Information

NPI Number	:	1104007137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINETIC ORTHOTICS, INC.

Provider Business Mailing Address
First Line	:	3958 ROSE AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1032
Country	:	US
Telephone Number	:	708-246-9249
Fax Number	:	708-246-9249

Provider Business Practice Location Address
First Line	:	3958 ROSE AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1032
Country	:	US
Telephone Number	:	708-246-9249
Fax Number	:	708-246-9249

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH SKERTICH
Credential	:
Telephone Number	:	708-246-9249

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	04/20/2008

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