Provider Demographics
NPI:1649499120
Name:OSTEOPATHIC MANIPULATIVE HEALTHCARE, S.C.
Entity type:Organization
Organization Name:OSTEOPATHIC MANIPULATIVE HEALTHCARE, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:HEINKING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-455-0472
Mailing Address - Street 1:6715 KINGERY HWY
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5142
Mailing Address - Country:US
Mailing Address - Phone:630-455-0472
Mailing Address - Fax:630-455-0213
Practice Address - Street 1:6715 KINGERY HWY
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5142
Practice Address - Country:US
Practice Address - Phone:630-455-0472
Practice Address - Fax:630-455-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1558462531OtherNPI INDIVIDUAL #
ILG32145Medicare UPIN