Provider Demographics
NPI:1053734954
Name:HEIL, THOMAS ALBERT JR (LAC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALBERT
Last Name:HEIL
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 W BERWYN AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2108
Mailing Address - Country:US
Mailing Address - Phone:773-516-1610
Mailing Address - Fax:
Practice Address - Street 1:4737 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7758
Practice Address - Country:US
Practice Address - Phone:872-216-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist