Healthcare Provider Details

I. General information

NPI: 1487879698
Provider Name (Legal Business Name): IRWIN L. HELLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 SHERMAN AVE
EVANSTON IL
60201-4421
US

IV. Provider business mailing address

1565 SHERMAN AVE
EVANSTON IL
60201-4421
US

V. Phone/Fax

Practice location:
  • Phone: 847-733-9900
  • Fax: 847-733-0105
Mailing address:
  • Phone: 847-733-9900
  • Fax: 847-733-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038006160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: