Provider Demographics
NPI:1437676731
Name:ROCKFORD WELLNESS ASSOCIATES, SC
Entity Type:Organization
Organization Name:ROCKFORD WELLNESS ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-708-0125
Mailing Address - Street 1:6019 FINCHAM DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2550
Mailing Address - Country:US
Mailing Address - Phone:815-708-0125
Mailing Address - Fax:815-316-1069
Practice Address - Street 1:6019 FINCHAM DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2550
Practice Address - Country:US
Practice Address - Phone:815-708-0125
Practice Address - Fax:815-316-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010875111N00000X
IL209011343261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty