Provider Demographics
NPI:1609126267
Name:ROCK VALLEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROCK VALLEY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CUPPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-732-2826
Mailing Address - Street 1:1307 W WASHINGTON ST
Mailing Address - Street 2:STE 115
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061
Mailing Address - Country:US
Mailing Address - Phone:815-732-2826
Mailing Address - Fax:815-732-7617
Practice Address - Street 1:1307 W WASHINGTON ST
Practice Address - Street 2:STE 115
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061
Practice Address - Country:US
Practice Address - Phone:815-732-2826
Practice Address - Fax:815-732-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty