Provider Demographics
NPI:1922096155
Name:HORST, PAUL RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:HORST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2948
Mailing Address - Country:US
Mailing Address - Phone:563-652-3191
Mailing Address - Fax:563-652-7008
Practice Address - Street 1:123 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2948
Practice Address - Country:US
Practice Address - Phone:563-652-3191
Practice Address - Fax:563-652-7008
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1274779Medicaid
IA47457Medicare ID - Type Unspecified
IAT26090Medicare UPIN