Provider Demographics
NPI:1033132881
Name:REXROTH, CURTIS L (DC)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:L
Last Name:REXROTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5005
Mailing Address - Country:US
Mailing Address - Phone:309-764-2115
Mailing Address - Fax:309-764-3292
Practice Address - Street 1:2330 53RD ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5005
Practice Address - Country:US
Practice Address - Phone:309-764-2115
Practice Address - Fax:309-764-3292
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8182060OtherBLUE CROSS BLUE SHIELD
ILT90660Medicare UPIN
IL8182060OtherBLUE CROSS BLUE SHIELD