Healthcare Provider Details

I. General information

NPI: 1003258211
Provider Name (Legal Business Name): MARK ROBERT DOERRFELD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 24TH ST
ROCK ISLAND IL
61201-5304
US

IV. Provider business mailing address

2514 24TH ST
ROCK ISLAND IL
61201-5304
US

V. Phone/Fax

Practice location:
  • Phone: 309-786-7246
  • Fax: 309-788-3638
Mailing address:
  • Phone: 309-786-7246
  • Fax: 309-788-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberL9947483
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: