Provider Demographics
NPI:1235402637
Name:ROCK RIVER WELLNESS, LLC
Entity Type:Organization
Organization Name:ROCK RIVER WELLNESS, LLC
Other - Org Name:ROCK RIVER CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-231-5774
Mailing Address - Street 1:1309 5TH ST
Mailing Address - Street 2:PO BOX 182
Mailing Address - City:ORION
Mailing Address - State:IL
Mailing Address - Zip Code:61273-7751
Mailing Address - Country:US
Mailing Address - Phone:515-231-5774
Mailing Address - Fax:
Practice Address - Street 1:2201 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6371
Practice Address - Country:US
Practice Address - Phone:515-231-5774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty