Healthcare Provider Details

I. General information

NPI: 1285873927
Provider Name (Legal Business Name): ANDINO CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2846 LANGSTONE DR
ROCKFORD IL
61109-1771
US

IV. Provider business mailing address

2846 LANGSTONE DR
ROCKFORD IL
61109-1771
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-7889
  • Fax:
Mailing address:
  • Phone: 815-397-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009900
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number038010991
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT ANDINO
Title or Position: OWNER
Credential: DC
Phone: 815-397-7889