Healthcare Provider Details

I. General information

NPI: 1437676731
Provider Name (Legal Business Name): ROCKFORD WELLNESS ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 FINCHAM DR
ROCKFORD IL
61108-2550
US

IV. Provider business mailing address

6019 FINCHAM DR
ROCKFORD IL
61108-2550
US

V. Phone/Fax

Practice location:
  • Phone: 815-708-0125
  • Fax: 815-316-1069
Mailing address:
  • Phone: 815-708-0125
  • Fax: 815-316-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010875
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number209011343
License Number StateIL

VIII. Authorized Official

Name: DR. KIMBERLY WILLIAMS
Title or Position: OWNER / PRESIDENT
Credential: DC
Phone: 815-708-0125