Provider Demographics
NPI:1124307301
Name:REHABILITATION & SPINAL CARE OF ROCKFORD SC
Entity type:Organization
Organization Name:REHABILITATION & SPINAL CARE OF ROCKFORD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-394-0309
Mailing Address - Street 1:483 N MULFORD RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5191
Mailing Address - Country:US
Mailing Address - Phone:815-394-0309
Mailing Address - Fax:815-394-0310
Practice Address - Street 1:483 N MULFORD RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5191
Practice Address - Country:US
Practice Address - Phone:815-394-0309
Practice Address - Fax:815-394-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty