Provider Demographics
NPI:1003632084
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:
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:469-902-8784
Mailing Address - Street 1:2373 CEDAR PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-3102
Mailing Address - Country:US
Mailing Address - Phone:517-908-0280
Mailing Address - Fax:
Practice Address - Street 1:2373 CEDAR PARK DR
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-3102
Practice Address - Country:US
Practice Address - Phone:517-908-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DJO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier