Healthcare Provider Details

I. General information

NPI: 1649499120
Provider Name (Legal Business Name): OSTEOPATHIC MANIPULATIVE HEALTHCARE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 KINGERY HWY
WILLOWBROOK IL
60527-5142
US

IV. Provider business mailing address

6715 KINGERY HWY
WILLOWBROOK IL
60527-5142
US

V. Phone/Fax

Practice location:
  • Phone: 630-455-0472
  • Fax: 630-455-0213
Mailing address:
  • Phone: 630-455-0472
  • Fax: 630-455-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. KURT PHILIP HEINKING
Title or Position: DIRECTOR
Credential: D.O.
Phone: 630-455-0472