Individual
EDIN ALIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5050 E STATE ST, ROCKFORD, IL 61108-2311
(773) 757-3454
Mailing address
5050 E STATE ST, ROCKFORD, IL 61108-2311
(773) 757-3454
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
10/18/2023
Last updated
01/26/2024
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