Provider Demographics
NPI:1063811149
Name:HORSEFEATHERS
Entity type:Organization
Organization Name:HORSEFEATHERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:EB
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-234-2411
Mailing Address - Street 1:1181 RIVERWOODS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3459
Mailing Address - Country:US
Mailing Address - Phone:847-234-2411
Mailing Address - Fax:847-905-0737
Practice Address - Street 1:1181 RIVERWOODS RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3459
Practice Address - Country:US
Practice Address - Phone:847-234-2411
Practice Address - Fax:847-905-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006145261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities