Provider Demographics
NPI:1114919552
Name:HORNE, WILLIAM KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEITH
Last Name:HORNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:KEITH
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:708 E DEUCE OF CLUBS
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-4926
Mailing Address - Country:US
Mailing Address - Phone:928-537-2963
Mailing Address - Fax:928-537-2965
Practice Address - Street 1:708 E DEUCE OF CLUBS
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-4926
Practice Address - Country:US
Practice Address - Phone:928-537-2963
Practice Address - Fax:928-537-2965
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1210403OtherAZ FOUNDATION
155186OtherAHCCCS
AZ155186Medicaid
AZAZ0231400OtherBCBS
AZT41750Medicare UPIN
AZ155186Medicaid