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General NPI Number Information
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NPI Number | 1164775581
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Entity Type | Organization
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Legal Business Name | FLUID MOTION CHIROPRACTIC, INC
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 128 JOHN ST
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City | ROCHESTER
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State | IL
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Zip | 62563-9570
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Country | US
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Telephone | 217-498-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 128 JOHN ST
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City | ROCHESTER
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State | IL
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Zip | 62563-9570
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Country | US
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Telephone | 217-498-1004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS ALLEN ZOBRIST
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Credential | D.C.
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Telephone | 217-498-1004
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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 | 038.012271
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License Number State | IL
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