Provider Demographics
NPI:1104989607
Name:ROY A HORN DC PA
Entity type:Organization
Organization Name:ROY A HORN DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-563-2597
Mailing Address - Street 1:9030 W FORT ISLAND TRAIL
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429
Mailing Address - Country:US
Mailing Address - Phone:352-563-2597
Mailing Address - Fax:352-563-2836
Practice Address - Street 1:9030 W FORT ISLAND TRAIL
Practice Address - Street 2:SUITE 10A
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429
Practice Address - Country:US
Practice Address - Phone:352-563-2597
Practice Address - Fax:352-563-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53997OtherBLUE CROSS BLUE SHIELD
FL53997OtherBLUE CROSS BLUE SHIELD
U81633Medicare UPIN