Provider Demographics
NPI:1679745574
Name:KOFOID, JAMES P (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:KOFOID
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3806 E STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2057
Mailing Address - Country:US
Mailing Address - Phone:815-978-6219
Mailing Address - Fax:815-397-7628
Practice Address - Street 1:3806 E STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2057
Practice Address - Country:US
Practice Address - Phone:815-978-6219
Practice Address - Fax:815-398-6435
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor