Provider Demographics
NPI:1679965115
Name:WIDER HORIZONS LLC
Entity Type:Organization
Organization Name:WIDER HORIZONS LLC
Other - Org Name:WIDER HORIZONS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:EBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-852-1330
Mailing Address - Street 1:3800 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2213
Mailing Address - Country:US
Mailing Address - Phone:414-852-1330
Mailing Address - Fax:
Practice Address - Street 1:3800 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2213
Practice Address - Country:US
Practice Address - Phone:414-852-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5026-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty