Healthcare Provider Details

I. General information

NPI: 1477555928
Provider Name (Legal Business Name): TODD RICHARD CEVENE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 E RIVERSIDE BLVD # 103
ROCKFORD IL
61114-4421
US

IV. Provider business mailing address

6451 E RIVERSIDE BLVD # 103
ROCKFORD IL
61114-4421
US

V. Phone/Fax

Practice location:
  • Phone: 815-639-9900
  • Fax: 815-639-9860
Mailing address:
  • Phone: 815-639-9900
  • Fax: 815-639-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008698
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: