Healthcare Provider Details

I. General information

NPI: 1518028828
Provider Name (Legal Business Name): INTEGRATED HEALTH, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/03/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6443 E. RIVERSIDE BOULEVARD SUITE101
ROCKFORD IL
61114
US

IV. Provider business mailing address

6443 E. RIVERSIDE BOULEVARD SUITE101
ROCKFORD IL
61114
US

V. Phone/Fax

Practice location:
  • Phone: 815-639-1090
  • Fax: 815-639-9860
Mailing address:
  • Phone: 815-639-1090
  • Fax: 815-639-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number042617189
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036049364
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6325720001
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036049364
License Number StateIL

VIII. Authorized Official

Name: DR. GREGORY T. KUHLMAN
Title or Position: OWNER
Credential: DC
Phone: 815-639-1090