Provider Demographics
NPI:1053320598
Name:HEIT, ROBERT KIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KIEL
Last Name:HEIT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 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:815-703-4738
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:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008430111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK03368Medicare ID - Type Unspecified
U45035Medicare UPIN