Provider Demographics
NPI:1245619717
Name:HORINE CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:HORINE CHIROPRACTIC CORPORATION
Other - Org Name:HORINE CHIROPRACTIC LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HORINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-625-1100
Mailing Address - Street 1:2336 W SUNNYSIDE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7299
Mailing Address - Country:US
Mailing Address - Phone:559-625-1100
Mailing Address - Fax:559-625-1110
Practice Address - Street 1:2336 W SUNNYSIDE AVE
Practice Address - Street 2:STE B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7298
Practice Address - Country:US
Practice Address - Phone:559-625-1100
Practice Address - Fax:559-625-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM214AMedicare PIN