Provider Demographics
NPI:1497731533
Name:DJO, LLC
Entity Type:Organization
Organization Name:DJO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP/CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TYRRELL-KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:866-356-7846
Mailing Address - Street 1:5919 SEA OTTER PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6750
Mailing Address - Country:US
Mailing Address - Phone:866-356-7846
Mailing Address - Fax:
Practice Address - Street 1:5919 SEA OTTER PL STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6750
Practice Address - Country:US
Practice Address - Phone:972-956-4323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165650741Medicaid