Provider Demographics
NPI:1922478981
Name:HEIT HEALTH AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:HEIT HEALTH AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-639-9900
Mailing Address - Street 1:6451 E RIVERSIDE BLVD
Mailing Address - Street 2:103
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4421
Mailing Address - Country:US
Mailing Address - Phone:815-639-9900
Mailing Address - Fax:815-639-9860
Practice Address - Street 1:6451 E RIVERSIDE BLVD
Practice Address - Street 2:103
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4421
Practice Address - Country:US
Practice Address - Phone:815-639-9900
Practice Address - Fax:815-639-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-03
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008430208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK03368OtherMEDICARE
ILU45035Medicare UPIN