NPI 1003900820

Orthopedic and Sports Enhancement Center, LLC

Organisation Specialist Bloomington, IL

Practice location

Address: 2406 E Empire St, Bloomington, IL 61704-3630
Phone: (309) 663-9300
Fax: (309) 661-1670

Authorised official

Name: J. Anthony Dustman
Title: President
Phone: (309) 663-9300

Registered specialties (2)

Specialist Primary

Other Service Providers Taxonomy 174400000X

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Orthopaedic Surgery Physician

Allopathic & Osteopathic Physicians Taxonomy 207X00000X

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Registry record

NPI: 1003900820
Entity type: Organization
NPI issued: 3 Oct 2006
Record last updated: 12 Sep 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.