Basic Information
| Provider Information | |||||||||
| NPI: | 1649886730 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIMPLY WELLNESS CHIROPRACTIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7117 CRIMSON RIDGE DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7792102001 | ||||||||
| FaxNumber: | 7792102005 | ||||||||
| Practice Location | |||||||||
| Address1: | 7117 CRIMSON RIDGE DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0000000000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2020 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROCKSTEAD | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8159703216 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.