Organization
CHUCK'S FOOT SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES A BOLINGER C.PED (LLC OWNER)
(260) 492-1752
Entity
Organization
Contact information
Practice address
4546 MAPLECREST RD, FORT WAYNE, IN 46835-3970
(260) 492-1752
(260) 492-1752
Mailing address
4546 MAPLECREST RD, FORT WAYNE, IN 46835-3970
(260) 492-1752
(260) 492-1752
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
1954
DE
Other
Enumeration date
12/27/2010
Last updated
12/27/2010
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