Provider Demographics
NPI:1366510133
Name:HORAITIS, RICHARD LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:HORAITIS
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 1:1216 N 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1804
Mailing Address - Country:US
Mailing Address - Phone:414-333-8458
Mailing Address - Fax:
Practice Address - Street 1:1216 N 8TH AVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-1804
Practice Address - Country:US
Practice Address - Phone:414-333-8458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70768Medicare ID - Type Unspecified