Provider Demographics
NPI:1689991713
Name:ROCKFORD PAIN CENTER LTD
Entity Type:Organization
Organization Name:ROCKFORD PAIN CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-316-7300
Mailing Address - Street 1:2902 MCFARLAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6801
Mailing Address - Country:US
Mailing Address - Phone:815-316-7300
Mailing Address - Fax:815-316-3483
Practice Address - Street 1:2902 MCFARLAND RD
Practice Address - Street 2:# 202
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6801
Practice Address - Country:US
Practice Address - Phone:815-633-8586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090181207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6665240001Medicare PIN
ILIL3487Medicare PIN