Healthcare Provider Details

I. General information

NPI: 1457334567
Provider Name (Legal Business Name): MICHAEL J. HEATWOLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7367 NORTH AVE
RIVER FOREST IL
60305-1230
US

IV. Provider business mailing address

7367 NORTH AVE
RIVER FOREST IL
60305-1230
US

V. Phone/Fax

Practice location:
  • Phone: 978-314-9349
  • Fax:
Mailing address:
  • Phone: 708-366-0066
  • Fax: 708-366-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: