ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC
NPI 1003900820
Specialist in Bloomington, IL

Q: What is Orthopedic And Sports Enhancement Center, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since October 03, 2006

2406 E EMPIRE ST, BLOOMINGTON, IL 61704(309) 663-9300(309) 661-1670 Get Directions Write a Review

NPPES record last updated: September 12, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Orthopedic And Sports Enhancement Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC (NPI 1003900820), doing business as Sports Enhancement Center, Llc, is a healthcare organization registered as a specialist in Bloomington, Illinois and active in the NPI registry since October 2006. The organization lists J. Anthony Dustman, President, as its authorized official.

NPPES Registry Identity

NPI1003900820

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC

Location Address2406 E EMPIRE STBloomington, IL 61704-3630

Mailing Address2406 E Empire StBloomington, IL 61704-3630 · (309) 663-9300 · Fax (309) 661-1670

Phone(309) 663-9300

Fax(309) 661-1670

Organization SubpartNo

Authorized OfficialJ. Anthony DustmanPresident · (309) 663-9300

Enumeration DateOctober 3, 2006

Last NPPES UpdateSeptember 12, 2017

✔ NPI 1003900820 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X

2406 E EMPIRE ST, Bloomington, IL 61704

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Other Names 1

Former Legal Business NameSports Enhancement Center, Llc

Other Identifiers 2

Medicare ID-Type Unspecified420960IL

Medicare NSC4452310001IL

Group Practice 2

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MILLENNIUM PAIN CENTER LLC

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