Custom Brace Shop Inc.
Durable Medical Equipment & Medical Supplies
872 W Dayton St, Galesburg
Illinois, 61401-1503
309-344-5330 309-344-5040
Custom Brace Shop Inc. is a Durable Medical Equipment & Medical Supplies in Galesburg, Illinois. It is located at 872 W Dayton St, Galesburg and it's customer support contact number is 309-344-5330. The authorized person of Custom Brace Shop Inc. is Mr. Fakhry Wilson Azer, P.T. who is President /owner of this DME and his contact number is 309-344-3400.
Custom Brace Shop Inc. is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
DME Supplier Details:
Custom Brace Shop Inc. type, location, contact phone number and fax are as below. Patients can directly walkin or can call on the below given customer support phone number for enquiries.
| Name: | Custom Brace Shop Inc. |
| Type: | Durable Medical Equipment & Medical Supplies |
| Location: | 872 W Dayton St, Galesburg,
Illinois, 61401-1503 |
| Phone: | 309-344-5330 |
| Fax: | 309-344-5040 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this supplier is as below. Person's position and contact details are also mentioned below.
| Name: | Mr. Fakhry Wilson Azer |
| Credentials: | P.T. |
| Position: | President /owner |
| Contact Number: | 309-344-3400 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given supplier are as mentioned below.
| NPI Number: | 1306865563 |
| NPI Enumeration Date: | 19 Jul, 2006 |
| NPI Last Update On: | 11 Jul, 2008 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Custom Brace Shop Inc. are as mentioned below.
| Specialization | License Number | State | Status | |
| Durable Medical Equipment & Medical Supplies | | | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of this supplier such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 30404878 | Other | Illinois | Certificate Of Registrati |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 872 W Dayton St,
Galesburg, Illinois |
| Zip: | 61401-1503 |
| Phone Number: | 309-344-5330 |
| Fax Number: | 309-344-5040 |
Patients can reach Custom Brace Shop Inc. at
872 W Dayton St, Galesburg, Illinois or can
call on customer care at 309-344-5330.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.