Provider Demographics
NPI:1720475676
Name:DIAMOND MEDICAL AND THERAPY GROUP, S.C.
Entity Type:Organization
Organization Name:DIAMOND MEDICAL AND THERAPY GROUP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOBASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-634-0757
Mailing Address - Street 1:1380 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60416-9785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1380 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:IL
Practice Address - Zip Code:60416-9785
Practice Address - Country:US
Practice Address - Phone:815-634-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty