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General NPI Number Information
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NPI Number | 1285873927
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Entity Type | Organization
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Legal Business Name | ANDINO CHIROPRACTIC
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 2846 LANGSTONE DR
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City | ROCKFORD
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State | IL
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Zip | 61109-1771
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Country | US
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Telephone | 815-397-7889
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Fax |
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Provider Business Mailing Address
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Address Line | 2846 LANGSTONE DR
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City | ROCKFORD
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State | IL
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Zip | 61109-1771
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Country | US
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Telephone | 815-397-7889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT ANDINO
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Credential | DC
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Telephone | 815-397-7889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 038010991
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038009900
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License Number State | IL
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