Provider Demographics
NPI:1376054544
Name:HEIZ-NERI, JEAN-RAFAEL R (PHD, LAC, MSOM, BS)
Entity Type:Individual
Prefix:DR
First Name:JEAN-RAFAEL
Middle Name:R
Last Name:HEIZ-NERI
Suffix:
Gender:M
Credentials:PHD, LAC, MSOM, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 W GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1905
Mailing Address - Country:US
Mailing Address - Phone:773-954-5422
Mailing Address - Fax:
Practice Address - Street 1:1208 W GRANVILLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1905
Practice Address - Country:US
Practice Address - Phone:773-954-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist