Provider Demographics
NPI:1326465022
Name:HORIZON CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:HORIZON CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-652-9887
Mailing Address - Street 1:1314 MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6700
Mailing Address - Country:US
Mailing Address - Phone:920-652-9887
Mailing Address - Fax:
Practice Address - Street 1:1314 MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6700
Practice Address - Country:US
Practice Address - Phone:920-652-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty