Provider Demographics
NPI:1063423234
Name:VAN HEULE, PIETER A (DC)
Entity type:Individual
Prefix:DR
First Name:PIETER
Middle Name:A
Last Name:VAN HEULE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2717
Mailing Address - Country:US
Mailing Address - Phone:847-251-0044
Mailing Address - Fax:847-251-0066
Practice Address - Street 1:522 POPLAR DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2717
Practice Address - Country:US
Practice Address - Phone:847-251-0044
Practice Address - Fax:847-251-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2009-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006449111N00000X
171100000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL932700Medicare PIN