Provider Demographics
NPI:1649886730
Name:SIMPLY WELLNESS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SIMPLY WELLNESS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-970-3216
Mailing Address - Street 1:7117 CRIMSON RIDGE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6213
Mailing Address - Country:US
Mailing Address - Phone:779-210-2001
Mailing Address - Fax:779-210-2005
Practice Address - Street 1:7117 CRIMSON RIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6213
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty