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General NPI Number Information
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NPI Number | 1609126267
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Entity Type | Organization
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Legal Business Name | ROCK VALLEY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1307 W WASHINGTON ST STE 115
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City | OREGON
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State | IL
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Zip | 61061
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Country | US
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Telephone | 815-732-2826
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Fax | 815-732-7617
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Provider Business Mailing Address
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Address Line | 1307 W WASHINGTON ST STE 115
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City | OREGON
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State | IL
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Zip | 61061
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Country | US
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Telephone | 815-732-2826
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Fax | 815-732-7617
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRANE T CUPPLES
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Credential | D.C.
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Telephone | 815-732-2826
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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 | 038011055
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License Number State | IL
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