Provider Demographics
NPI:1023205770
Name:WISNIEWSKI, HEATHER (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROOSEVELT RD
Mailing Address - Street 2:SUITE A109
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5839
Mailing Address - Country:US
Mailing Address - Phone:630-942-1234
Mailing Address - Fax:630-942-8855
Practice Address - Street 1:800 ROOSEVELT RD
Practice Address - Street 2:SUITE A109
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5839
Practice Address - Country:US
Practice Address - Phone:630-942-1234
Practice Address - Fax:630-942-8855
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009374111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition