Provider Demographics
NPI:1164097705
Name:REALIGN FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:REALIGN FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOUFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-921-8830
Mailing Address - Street 1:1817 CEDARBROOK LN UNIT 11
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-5256
Mailing Address - Country:US
Mailing Address - Phone:608-921-8830
Mailing Address - Fax:
Practice Address - Street 1:4877 LARSON BEACH RD
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8735
Practice Address - Country:US
Practice Address - Phone:608-921-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty