Provider Demographics
NPI:1205838687
Name:HORAK, STEVEN WILLIAM (DC,CCSP)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WILLIAM
Last Name:HORAK
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50630-0323
Mailing Address - Country:US
Mailing Address - Phone:563-237-6559
Mailing Address - Fax:
Practice Address - Street 1:111 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:IA
Practice Address - Zip Code:50630
Practice Address - Country:US
Practice Address - Phone:563-237-6560
Practice Address - Fax:563-237-6562
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05724111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0106864Medicaid
IA13692Medicare ID - Type Unspecified
IA0106864Medicaid