Healthcare Provider Details

I. General information

NPI: 1801702691
Provider Name (Legal Business Name): INNERVITAL WABASH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE STE 1801
CHICAGO IL
60602-2975
US

IV. Provider business mailing address

211 W WACKER DR STE 120-2357
CHICAGO IL
60606-1217
US

V. Phone/Fax

Practice location:
  • Phone: 312-244-5555
  • Fax:
Mailing address:
  • Phone: 312-244-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEAN-RAFAEL ROGER HEIZ
Title or Position: MEMBER-MANAGER
Credential: L.AC.
Phone: 312-244-2555