ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER LLC NPI 1003900820

NPI Information

ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC is a specialist in Bloomington, IL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC NPI is 1003900820. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Former Legal Business Name Is Sports Enhancement Center, Llc.

The provider's business location address is:

2406 E EMPIRE ST
BLOOMINGTON, IL
ZIP 61704-630
Phone: (309) 663-9300
Fax: (309) 661-1670

The provider's authorized official is J. Anthony Dustman .
The authorized official title is President and has the following contact phone number (309) 663-9300.

The enumeration date for this NPI number is 10/3/2006 and was last updated on 9/12/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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