Provider Demographics
NPI:1124039391
Name:ROCKFORD SPINE CENTER, LTD
Entity Type:Organization
Organization Name:ROCKFORD SPINE CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-316-2100
Mailing Address - Street 1:2902 MCFARLAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6801
Mailing Address - Country:US
Mailing Address - Phone:815-316-2100
Mailing Address - Fax:815-316-2099
Practice Address - Street 1:2902 MCFARLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6801
Practice Address - Country:US
Practice Address - Phone:815-316-2100
Practice Address - Fax:815-316-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-617984207X00000X, 207XS0117X, 208100000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4862350001Medicare NSC