| NPI | 1811986532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD GOERTZEN President 309-676-2276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: IL 211000032) |
| 224P00000X Prosthetist (Licence: IL 213000024) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2018-07-30 |