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General NPI Number Information
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NPI Number | 1245412998
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Entity Type | Organization
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Legal Business Name | VILLAGE CHIROPRACTIC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1639 N ALPINE RD 503
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City | ROCKFORD
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State | IL
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Zip | 61107-1449
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Country | US
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Telephone | 815-398-3334
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Fax | 815-398-3469
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Provider Business Mailing Address
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Address Line | 1639 N ALPINE RD 503
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City | ROCKFORD
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State | IL
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Zip | 61107-1449
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Country | US
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Telephone | 815-398-3334
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Fax | 815-398-3469
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH B POTETTI
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Credential | D.C.
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Telephone | 815-398-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | IL
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