Provider Demographics
NPI:1740272194
Name:ROCKWELL, VIVIAN G (DC)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:G
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 NE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3928
Mailing Address - Country:US
Mailing Address - Phone:541-382-5866
Mailing Address - Fax:
Practice Address - Street 1:2226 NE MEADOW LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3928
Practice Address - Country:US
Practice Address - Phone:541-382-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGDDRMedicare ID - Type UnspecifiedMEDICARE