Individual
MR. DENNIS WAYNE DILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.PED., CTO
Contact information
Practice address
741 W MAIN ST, PEORIA, IL 61606-2017
(309) 676-2276
Mailing address
10823 W SMITHVILLE RD, HANNA CITY, IL 61536-9711
(309) 565-7133
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
212-000127
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212-000127
STATE LICENSED PEDORTHIST
IL
01
—
CPED1563
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS, INC.
IL
Enumeration date
03/15/2007
Last updated
11/09/2012
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