Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-008430 | IL |
NPI | 1053320598 |
---|---|
Provider Name | Dr. Robert Kiel Heit |
First Address | Rockford, IL 61108-2678 |
Second Address | Rockford, IL 61108-2678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 13/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U45035 | (02) |