Provider Demographics
NPI:1790796159
Name:ROCKFORD CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:ROCKFORD CHIROPRACTIC CORPORATION
Other - Org Name:ROCKFORD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KARG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-477-5720
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-0250
Mailing Address - Country:US
Mailing Address - Phone:763-477-6569
Mailing Address - Fax:866-595-5649
Practice Address - Street 1:9000 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373
Practice Address - Country:US
Practice Address - Phone:763-477-5720
Practice Address - Fax:866-595-5649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKFORD CHIROPRACTIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3765111N00000X
MN4723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN491068100Medicaid
MNU80235Medicare UPIN
MNC03764Medicare ID - Type UnspecifiedGROUP NUMBER
MN491068100Medicaid