Healthcare Provider Details

I. General information

NPI: 1427004084
Provider Name (Legal Business Name): NECK TO BACK ROCKFORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7177 CRIMSON RIDGE DRIVE STE 7
ROCKFORD IL
61107
US

IV. Provider business mailing address

7177 CRIMSON RIDGE DRIVE STE 14
ROCKFORD IL
61107
US

V. Phone/Fax

Practice location:
  • Phone: 815-227-9900
  • Fax: 815-227-9805
Mailing address:
  • Phone: 815-227-9900
  • Fax: 815-227-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DEAN A WHITCOMB
Title or Position: CFO
Credential:
Phone: 815-227-9900