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General NPI Number Information
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NPI Number | 1124307301
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Entity Type | Organization
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Legal Business Name | REHABILITATION & SPINAL CARE OF ROCKFORD SC
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 483 N MULFORD RD SUITE 7
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City | ROCKFORD
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State | IL
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Zip | 61107-5191
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Country | US
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Telephone | 815-394-0309
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Fax | 815-394-0310
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Provider Business Mailing Address
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Address Line | 483 N MULFORD RD SUITE 7
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City | ROCKFORD
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State | IL
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Zip | 61107-5191
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Country | US
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Telephone | 815-394-0309
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Fax | 815-394-0310
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Authorized Official
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Title or Position | OWNER/OPERATOR/PRESIDENT
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Name | DR. MICHAEL TIMOTHY DONOHUE
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Credential | D.C.
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Telephone | 815-394-0309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.011639
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License Number State | IL
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