Provider Demographics
NPI:1962546630
Name:ROCKWOOD, JENNIFER LEE (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:ROCKWOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:ROCKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:900 W IL ROUTE 22
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3416
Mailing Address - Country:US
Mailing Address - Phone:847-719-5800
Mailing Address - Fax:847-847-1442
Practice Address - Street 1:900 W IL ROUTE 22
Practice Address - Street 2:SUITE 160
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3416
Practice Address - Country:US
Practice Address - Phone:847-719-5800
Practice Address - Fax:847-847-1442
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0034940786OtherBLUE CROSS BLUE SHIELD