Provider Demographics
NPI:1831676360
Name:HORSTMAN, CALLIE MAE (DC)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:MAE
Last Name:HORSTMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HALE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-3305
Mailing Address - Country:US
Mailing Address - Phone:608-501-1062
Mailing Address - Fax:
Practice Address - Street 1:120 HALE DR STE 3
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-3305
Practice Address - Country:US
Practice Address - Phone:608-501-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5368-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor