Organization
NISSI CORP
Active
Other names
The Good Feet Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE EDWARD BUCKMAN III CERTIFIED PEDORTHIST (PRESIDENT)
(815) 654-1900
Entity
Organization
Contact information
Practice address
5823 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4963
(815) 654-1900
Mailing address
5823 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4963
(815) 654-1900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
212000137
IL
Other
Enumeration date
02/13/2008
Last updated
06/09/2008
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