Healthcare Provider Details

I. General information

NPI: 1124039391
Provider Name (Legal Business Name): ROCKFORD SPINE CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 MCFARLAND RD SUITE 300
ROCKFORD IL
61107-6801
US

IV. Provider business mailing address

2902 MCFARLAND RD SUITE 300
ROCKFORD IL
61107-6801
US

V. Phone/Fax

Practice location:
  • Phone: 815-316-2100
  • Fax: 815-316-2099
Mailing address:
  • Phone: 815-316-2100
  • Fax: 815-316-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number042-617984
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number042-617984
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number042-617984
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number042-617984
License Number StateIL

VIII. Authorized Official

Name: JACQUELINE SPIELMAN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 815-316-2100