Provider Demographics
NPI:1245561661
Name:DIABETIC FOOTWEAR SOLUTUIONS LLC
Entity Type:Organization
Organization Name:DIABETIC FOOTWEAR SOLUTUIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:VAN DIGGELEN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:815-444-7239
Mailing Address - Street 1:1424 E JONQUIL CIR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3558
Mailing Address - Country:US
Mailing Address - Phone:847-255-5306
Mailing Address - Fax:
Practice Address - Street 1:1 CRYSTAL LAKE PLZ
Practice Address - Street 2:SUITE AW
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7966
Practice Address - Country:US
Practice Address - Phone:815-444-7239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies