Provider Demographics
NPI:1508122649
Name:SPADAFINO, CAROLYN E (DC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:E
Last Name:SPADAFINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:E
Other - Last Name:KUSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3779 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4807
Mailing Address - Country:US
Mailing Address - Phone:815-633-9115
Mailing Address - Fax:815-633-8745
Practice Address - Street 1:3779 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4807
Practice Address - Country:US
Practice Address - Phone:815-633-9115
Practice Address - Fax:815-633-8745
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor