Provider Demographics
NPI:1184032302
Name:INFINITE HORIZON CHIROPRACTIC
Entity Type:Organization
Organization Name:INFINITE HORIZON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DYSART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-683-6204
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:WY
Mailing Address - Zip Code:82730
Mailing Address - Country:US
Mailing Address - Phone:307-363-3859
Mailing Address - Fax:307-685-7139
Practice Address - Street 1:504 PINE ST.
Practice Address - Street 2:APT. 7
Practice Address - City:UPTON
Practice Address - State:WY
Practice Address - Zip Code:82730
Practice Address - Country:US
Practice Address - Phone:307-363-3859
Practice Address - Fax:307-685-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty