Provider Demographics
NPI:1336296359
Name:HEALTH CARE ENTERPRISE
Entity Type:Organization
Organization Name:HEALTH CARE ENTERPRISE
Other - Org Name:BODY FITNESS PHYSICAL MEDICINE & SPORTS INJURY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR - CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTIC PHYSICI
Authorized Official - Phone:815-725-8200
Mailing Address - Street 1:707 W JEFFERSON STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404
Mailing Address - Country:US
Mailing Address - Phone:815-725-8200
Mailing Address - Fax:815-730-8576
Practice Address - Street 1:707 W JEFFERSON STREET
Practice Address - Street 2:SUITE F
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404
Practice Address - Country:US
Practice Address - Phone:815-725-8200
Practice Address - Fax:815-730-8576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932246OtherBCBS
IL211653Medicare ID - Type Unspecified
IL9932246OtherBCBS