Provider Demographics
NPI:1780459388
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 1:2400 COUNTY ROAD D W STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-8503
Mailing Address - Country:US
Mailing Address - Phone:612-445-9191
Mailing Address - Fax:
Practice Address - Street 1:2400 COUNTY ROAD D W STE 110
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-8503
Practice Address - Country:US
Practice Address - Phone:612-445-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DJO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-24
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier