Provider Demographics
NPI:1750672671
Name:JAMES KOFOID CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:JAMES KOFOID CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOFOID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-978-6219
Mailing Address - Street 1:3806 E STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2057
Mailing Address - Country:US
Mailing Address - Phone:815-978-6219
Mailing Address - Fax:815-397-7628
Practice Address - Street 1:3806 E STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2057
Practice Address - Country:US
Practice Address - Phone:815-978-6219
Practice Address - Fax:815-397-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.008132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty