Provider Demographics
NPI:1326199936
Name:HORBACH, CASEY JOHN (DC DOCTOR OF CHIROPR)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:JOHN
Last Name:HORBACH
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12027 ANTIOCH RD
Mailing Address - Street 2:UNIT F
Mailing Address - City:TREVOR
Mailing Address - State:WI
Mailing Address - Zip Code:53179
Mailing Address - Country:US
Mailing Address - Phone:262-862-6001
Mailing Address - Fax:262-862-1315
Practice Address - Street 1:12027 ANTIOCH RD
Practice Address - Street 2:UNIT F
Practice Address - City:TREVOR
Practice Address - State:WI
Practice Address - Zip Code:53179
Practice Address - Country:US
Practice Address - Phone:262-862-6001
Practice Address - Fax:262-862-1315
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4044012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIV03530Medicare UPIN