Provider Demographics
NPI:1679859029
Name:DUPAGE PROSTHETIC-ORTHOTIC SERVICE INC.
Entity Type:Organization
Organization Name:DUPAGE PROSTHETIC-ORTHOTIC SERVICE INC.
Other - Org Name:DUPAGE PROSTHETIC-ORTHOTIC SERVICE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LO, LCED
Authorized Official - Phone:630-261-9317
Mailing Address - Street 1:121 E ROOSEVELT RD
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4561
Mailing Address - Country:US
Mailing Address - Phone:630-261-9317
Mailing Address - Fax:630-261-9319
Practice Address - Street 1:1100 SHERMAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8608
Practice Address - Country:US
Practice Address - Phone:630-261-9317
Practice Address - Fax:630-261-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213.000230335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2271316OtherBC/BS