1962546630 NPI number — JENNIFER LEE ROCKWOOD DC

Table of content: JENNIFER LEE ROCKWOOD DC (NPI 1962546630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962546630 NPI number — JENNIFER LEE ROCKWOOD DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCKWOOD
Provider First Name:
JENNIFER
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROCKWOOD
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962546630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 W IL ROUTE 22
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
LAKE ZURICH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60047-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-719-5800
Provider Business Mailing Address Fax Number:
847-847-1442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W IL ROUTE 22
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
LAKE ZURICH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60047-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-719-5800
Provider Business Practice Location Address Fax Number:
847-847-1442
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038-007760 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0034940786 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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