Provider Demographics
NPI:1750358669
Name:HISHON, HEATH WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:WILLIAM
Last Name:HISHON
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 1:5001 N UNIVERSITY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4799
Mailing Address - Country:US
Mailing Address - Phone:309-693-2225
Mailing Address - Fax:309-693-2228
Practice Address - Street 1:5001 N UNIVERSITY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4799
Practice Address - Country:US
Practice Address - Phone:309-693-2225
Practice Address - Fax:309-693-2228
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-010100OtherSTATE LICENSE
ILK10873OtherOTHER MEDICARE IDENTIFIER
ILK10873OtherOTHER MEDICARE IDENTIFIER
IL209982Medicare ID - Type Unspecified