Healthcare Provider Details

I. General information

NPI: 1356754592
Provider Name (Legal Business Name): ROSENTHAL CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SUMMIT ST
GALENA IL
61036-1636
US

IV. Provider business mailing address

202 SUMMIT ST
GALENA IL
61036-1636
US

V. Phone/Fax

Practice location:
  • Phone: 815-776-0595
  • Fax: 815-776-0595
Mailing address:
  • Phone: 815-776-0595
  • Fax: 815-776-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number007243
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4551012
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number038011927
License Number StateIL

VIII. Authorized Official

Name: DR. REBECCA ANN ROSENTHAL
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 815-776-0595