Healthcare Provider Details

I. General information

NPI: 1326211194
Provider Name (Legal Business Name): STEVE ROGNE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7102 N DAMEN AVE #3
CHICAGO IL
60645-2469
US

IV. Provider business mailing address

7102 N DAMEN AVE #3
CHICAGO IL
60645-2469
US

V. Phone/Fax

Practice location:
  • Phone: 773-330-1970
  • Fax:
Mailing address:
  • Phone: 773-330-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.021019
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: