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NPI Code Detail

MEDICARE: CRAIG S ROCKWELL DC PLLC

MEDICARE: CRAIG S ROCKWELL DC PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320700000XPhysical Disabilities Residential Treatment Facility2301004746MI

General Provider Information

NPI Number : 1750642997
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRAIG S ROCKWELL DC PLLC
Provider Business Mailing Address
First Line : 7579 MAIN ST
Second Line :
City : JENISON
State : MI
Zip : 49428-9251
Country : US
Telephone Number : 616-457-4511
Fax Number : 616-667-1936
Provider Business Practice Location Address
First Line : 7579 MAIN ST
Second Line :
City : JENISON
State : MI
Zip : 49428-9251
Country : US
Telephone Number : 616-457-4511
Fax Number : 616-667-1936
Authorized Official
Title or Position : SOLE MBR
Name : DR. CRAIG STEPHEN ROCKWELL
Credential : DC
Telephone Number : 616-457-4511
Provider Enumeration Date : 06/05/2012
Last Update Date : 06/05/2012

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