Provider Demographics
NPI:1639398340
Name:HORVATH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HORVATH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HORVATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-443-7496
Mailing Address - Street 1:112 VINEYARD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-3104
Mailing Address - Country:US
Mailing Address - Phone:252-977-8977
Mailing Address - Fax:
Practice Address - Street 1:112 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2235
Practice Address - Country:US
Practice Address - Phone:252-443-7496
Practice Address - Fax:252-443-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1935111NS0005X
AL1182111NS0005X
MI006532111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890851-VMedicaid
NC2449186BOtherMEDICARE PTAN
NCV-23035Medicare UPIN