Basic Information
| Provider Information | |||||||||
| NPI: | 1851831044 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCKING HORSE CHILDREN'S HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROCKING HORSE CENTER CHIROPRACTIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 S LIMESTONE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455051965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373241111 | ||||||||
| FaxNumber: | 9375254541 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 S LIMESTONE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373241111 | ||||||||
| FaxNumber: | 9375254543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2017 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | SHONDA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9373241111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NX0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Orthopedic |
No ID Information.