Provider Demographics
NPI:1295857787
Name:DAN KING THERAPY SERVICES
Entity Type:Organization
Organization Name:DAN KING THERAPY SERVICES
Other - Org Name:COMMUNITY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-230-9788
Mailing Address - Street 1:521 S LA GRANGE RD
Mailing Address - Street 2:SUITE 204-A
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6700
Mailing Address - Country:US
Mailing Address - Phone:708-482-9788
Mailing Address - Fax:708-482-9789
Practice Address - Street 1:521 S LA GRANGE RD
Practice Address - Street 2:SUITE 204-A
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6700
Practice Address - Country:US
Practice Address - Phone:708-482-9788
Practice Address - Fax:708-482-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000443332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0936140001Medicare NSC