Provider Demographics
NPI:1578801585
Name:BARNEVELD FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BARNEVELD FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HORSFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-924-2424
Mailing Address - Street 1:101 S JONES ST
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9801
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:53507-9801
Practice Address - Country:US
Practice Address - Phone:608-924-2424
Practice Address - Fax:608-924-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3813-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35481Medicaid
WIWI3042OtherMEDICARE PTAN