Provider Demographics
NPI:1396132692
Name:KB CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:KB CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-229-5568
Mailing Address - Street 1:431 PHELPS AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3101
Mailing Address - Country:US
Mailing Address - Phone:815-229-5568
Mailing Address - Fax:815-860-1674
Practice Address - Street 1:431 PHELPS AVE STE 601
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3101
Practice Address - Country:US
Practice Address - Phone:815-229-5568
Practice Address - Fax:815-860-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty