Provider Demographics
NPI:1174885107
Name:ROCKFORD PAIN MANAGEMENT LTD
Entity type:Organization
Organization Name:ROCKFORD PAIN MANAGEMENT LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:CEVENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-639-1090
Mailing Address - Street 1:6451 E RIVERSIDE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4421
Mailing Address - Country:US
Mailing Address - Phone:815-639-1090
Mailing Address - Fax:815-639-9860
Practice Address - Street 1:6451 E RIVERSIDE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4421
Practice Address - Country:US
Practice Address - Phone:815-639-1090
Practice Address - Fax:815-639-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty