Healthcare Provider Details

I. General information

NPI: 1841593290
Provider Name (Legal Business Name): DAVID R LOVE ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9393 BELOIT RD
BELVIDERE IL
61008-9735
US

IV. Provider business mailing address

970 STONEFIELD LN
ROCKFORD IL
61108-2591
US

V. Phone/Fax

Practice location:
  • Phone: 815-547-3901
  • Fax:
Mailing address:
  • Phone: 815-766-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.002339
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: