Provider Demographics
NPI:1013027440
Name:HEIT REHABILITATION & OPTIMAL HEALTH CENTER S C
Entity Type:Organization
Organization Name:HEIT REHABILITATION & OPTIMAL HEALTH CENTER S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KIEL
Authorized Official - Last Name:HEIT
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:815-399-5860
Mailing Address - Street 1:7445 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2678
Mailing Address - Country:US
Mailing Address - Phone:815-399-5860
Mailing Address - Fax:815-399-6107
Practice Address - Street 1:7445 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2678
Practice Address - Country:US
Practice Address - Phone:815-399-5860
Practice Address - Fax:815-399-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617472111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1032067OtherBLUE CROSS / BLUE SHIELD
IL208119Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER