Provider Demographics
NPI:1326038514
Name:HORN, MICHAEL C (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:HORN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1141
Mailing Address - Country:US
Mailing Address - Phone:205-758-2225
Mailing Address - Fax:205-758-2251
Practice Address - Street 1:1515 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1141
Practice Address - Country:US
Practice Address - Phone:205-758-2225
Practice Address - Fax:205-758-2251
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1130OtherLICENSE # ST BD OF CHIRO
ALT68449Medicare UPIN
AL051558399Medicare PIN