Provider Demographics
NPI:1407885767
Name:HORSFALL, KIMBERLY A (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:HORSFALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:KIRCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:101 S. JONES ST.
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507
Mailing Address - Country:US
Mailing Address - Phone:608-924-2424
Mailing Address - Fax:608-924-2425
Practice Address - Street 1:101 S. JONES ST.
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:WI
Practice Address - Zip Code:53507
Practice Address - Country:US
Practice Address - Phone:608-924-2424
Practice Address - Fax:608-924-2425
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3813012111N00000X
WI3813-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI3042OtherMEDICARE PTAN
WI38935100Medicaid
WI000035754Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER