Provider Demographics
NPI:1528254893
Name:HORBACH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HORBACH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-862-6001
Mailing Address - Street 1:12027 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:TREVOR
Mailing Address - State:WI
Mailing Address - Zip Code:53179-9660
Mailing Address - Country:US
Mailing Address - Phone:262-862-6001
Mailing Address - Fax:262-862-1315
Practice Address - Street 1:12027 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:TREVOR
Practice Address - State:WI
Practice Address - Zip Code:53179-9660
Practice Address - Country:US
Practice Address - Phone:262-862-6001
Practice Address - Fax:262-862-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WISB950OtherBCBS