Provider Demographics
NPI:1932694759
Name:ROCKFORD CHIROPRACTIC NEUROLOGY AND NUTRITION CENTER, LTD.
Entity Type:Organization
Organization Name:ROCKFORD CHIROPRACTIC NEUROLOGY AND NUTRITION CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WINTHROP
Authorized Official - Last Name:SAHLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-200-3612
Mailing Address - Street 1:124 N WATER ST STE 204E
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3959
Mailing Address - Country:US
Mailing Address - Phone:815-200-3612
Mailing Address - Fax:
Practice Address - Street 1:124 N WATER ST STE 204E
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3959
Practice Address - Country:US
Practice Address - Phone:815-200-3612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty