Healthcare Provider Details

I. General information

NPI: 1013027440
Provider Name (Legal Business Name): HEIT REHABILITATION & OPTIMAL HEALTH CENTER S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 E STATE ST
ROCKFORD IL
61108-2678
US

IV. Provider business mailing address

7445 E STATE ST
ROCKFORD IL
61108-2678
US

V. Phone/Fax

Practice location:
  • Phone: 815-399-5860
  • Fax: 815-399-6107
Mailing address:
  • Phone: 815-399-5860
  • Fax: 815-399-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number042617472
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT KIEL HEIT
Title or Position: CLINIC DIRECTOR
Credential: D. C.
Phone: 815-399-5860