Individual
DR. ANDREW KONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
5301 E STATE ST, SUITE 101 BACK IN ACTION HOLISTIC HEALTH CENTER, ROCKFORD, IL 61108
(815) 397-8500
(815) 397-8588
Mailing address
5301 E STATE ST, STE 101, ROCKFORD, IL 61108
(815) 397-8500
(815) 397-8588
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038007316
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010132077
BLUE CROSS BLUE SHIELD
—
01
—
331054985
TAX ID
—
Enumeration date
01/17/2007
Last updated
07/08/2007
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