Provider Demographics
NPI:1043577935
Name:BETTER BODY BOOT CAMP INC
Entity Type:Organization
Organization Name:BETTER BODY BOOT CAMP INC
Other - Org Name:DS MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SALES
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-323-0326
Mailing Address - Street 1:23280 W LONE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9063
Mailing Address - Country:US
Mailing Address - Phone:847-323-0326
Mailing Address - Fax:
Practice Address - Street 1:23280 W LONE TREE LN
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-9063
Practice Address - Country:US
Practice Address - Phone:847-323-0326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1043577935251E00000X, 305R00000X, 332B00000X, 332BN1400X
3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy