Provider Demographics
NPI:1306065958
Name:LINDHOLM, ERIK JAMES (CPO, LPO, ATC)
Entity type:Individual
Prefix:MR
First Name:ERIK
Middle Name:JAMES
Last Name:LINDHOLM
Suffix:
Gender:M
Credentials:CPO, LPO, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BLACK RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3962
Mailing Address - Country:US
Mailing Address - Phone:815-531-5386
Mailing Address - Fax:
Practice Address - Street 1:1316 BLACK RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3962
Practice Address - Country:US
Practice Address - Phone:815-531-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0020492255A2300X
IL213000217222Z00000X
IL211000293224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist